Most providers do not really know that they can also bill for virtual checkins.
This service can be provided by a physician to a new or established patient, parent, or guardian.
This cannot be originating from a related E/M service provided within the previous seven days.
This cannot also be leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
This can include patient initiated phone calls OR image/video sent by patient and reviewed asynchronously by the provider (read the telemedicine intro here)
Barriers to offering virtual check-ins
First of all, most practices shy away from telling patients that they can access their doctors via the patient portal or a patient app.
The biggest reason for this being that providers are worried that patients will badger them at all hours of the day.
That’s simply not true.
Your patient portal or a patient app is a GREAT way to increase patient access and improve patient reviews.
Increasing patient access has an undeniably high impact on patient satisfaction and getting more reviews.
This has a direct effect on your medical marketing.
It’s all inter-related.
Steps to take towards offering virtual check-ins
The first step to take is to let your providers know that they can bill for telecheckins / virtual checkins.
The next step is to make sure that when patients call in to “speak to the doctor”, each patient is given an appointment that’s on the schedule/calendar for the provider.
Some providers prefer to make all the patient calls at the end of the day or in a set block of time.
That’s perfectly OK to do — go ahead and schedule those patient phone calls.
The provider can call the patient from the office line (so that the patient doesn’t know the provider’s direct phone number), or can use *69 and dial the patient’s phone number (although, that leads to patients not picking up the call as it is an unidentified number) or they can use a messaging app.
Regardless, the provider does not have to worry about patients finding out their direct phone number.
Ideally, the provider calls the patient using a telemedicine solution.
This ensures that the phone call durations are documented for audit purposes.
It also helps the billing department gets the necessary billing information.
Finally, the phone calls are scheduled and sync with the EMR, therefore helping your patient contact center.
The right technology vendor solves it
Try to find a vendor with an integrated solution for phone calls, telehealth, secure messaging.
This truly helps as your patient can simply use the patient app and write to you, send images or videos of their issue or you can hop on a call with the patient as well.
Your provider can also bill for the time spent in evaluating any image/video sent by patient and reviewed asynchronously by the provider.
As long as it is patient initiated, you are good to go.
Make the right telemedicine technology vendor choice and you can very well make telemedicine a profitable line of service.
How to increase patient access with online digital E/M
Online digital E/M is yet another way that you can extend care to patients beyond traditional office visits.
As I have always mentioned, ensuring the highest patient access leads to higher patient satisfaction, thereby leading to higher patient reviews and ultimately, contributes to increased patient volumes.
You can deliver online digital E/M synchronously and asynchronously and audio/video phone can be used.
Please note that you cannot use a traditional phone.
As with the other cases, this has to be patient initiated as well and the patient consent has to be recorded.
Patient consent can be verbal and practices do not have to document this consent in any system.
When can you use this?
Consider this vignette — a patient calls in and initiates a virtual check-in.
Now, your practice lets the patient know about their options.
If the patient then calls back within 7 days, you can take that virtual check-in (lower, G2012) time and add it to the digital E/M code (99421–99423) .
Thereafter, you bill ONLY the digital E/M code.
You, of course, cannot use this for communication of test results, scheduling of appointments, or other communication that does not include E/M.
This has to be an established patient, so please keep that in mind.
The patient’s problem may be new to the clinician.
However, you cannot use this for new patients.
You can use this only once per 7-day period and unfortunately clinical staff time is not included in this.
Documentation and the billing rules are the biggest headaches
As you can see, documenting time and keeping track of all the rules are quite important in most of telehealth situations.
While you and your biller can do this manually, it is always recommended to use a telemedicine technology solution that incorporates this rules engine within the software.
Otherwise, you end up spending more time and resources in figuring out billing and recording time than the potential profits you could make.
Typically, this is done via a secure patient portal that’s already included in your EMR (whichever EMR you use).
However, traditionally, we have seen that adoption of patient portals is low when it is web based and clunky (which most EMR patient portals are).
I have seen a much higher adoption and usage of patient mobile apps because these apps typically allow you to manage appointments, manage prescriptions, demographics, include provider finders etc.
My recommendation is to use patient mobile app/portals because patients seem to adopt it more than patient portals.
Once you have your patients on the patient portal / mobile app, your practice should encourage patients to write to your providers.
It is a HUGE differentiator from a marketing point of view and is something that should also be put up on the practice/hospital website as well.
You can also advertise this VERY easily by simply sending an SMS to everyone that calls your front desk (e.g. if you leverage a VOIP solution like Amazon connect).
Hopefully this gives you enough information to get started with marketing and billing for online digital E/M services.