Helpful Tips

Charging For Telephone Care

A New Trend

The demand from patients for telephone, email, and web-based access to medical care is on the rise. The addition of new codes for telephone services to CPT 2008 provides recognition of these new methods of delivering healthcare. Studies have shown that patient satisfaction with telephone care is generally quite high, and many patients are willing to pay for the service. Insurance plans, recognizing the cost-effectiveness of telephone care and online encounters, are implementing policies that will allow physicians to bill patients directly for this type of care.

Decide if it’s right for you and your practice

Calculate the cost to your practice

The ethical and practical considerations surrounding the decision to collect a fee for services that have been traditionally provided at no cost is challenging for most physicians. Almost all physicians agree, however, that in today’s healthcare payment system, it is difficult to make the case that physicians should be expected to provide medical care and treatment for free. Among physicians, opinions vary regarding the actual financial value of telephone care, and whether or not to implement an office policy to charge for the service.

Reluctance to implement such a policy may be based on the following concerns:

  • May cause patients to transfer their care to another practice
  • May deter patients with serious problems from calling
  • Creates a negative image of physicians
  • Low reimbursement not worth meeting the documentation requirements and costs associated with billing and collections
  • A need for criteria which would identify phone calls which are billable vs. calls which should not be billed

Those in favor of charging for telephone care cite the following reasons:

  • Decreasing or “flat-line” reimbursement from third party payers in an environment of increasing overhead, and more telephone care
  • Increasing numbers of patients who insist on telephone care because employment and family-time commitments leave little opportunity for doctor appointments
  • More cost effective than self-referred trips to the ED, unnecessary office visits, and a better use of health care resources
  • Documentation requirements for reimbursable telephone care would result in enhanced risk-management, and better continuity of care

Do your homework

Contact each of your payers. Find out which ones pay for the service, what the coverage guidelines and billing requirements are, whether the service is subject to a co-pay or co-insurance/deductible, and what the allowance is for each of the codes. Find out if there is anything in your contract that would preclude you from billing for this type of service. If you are considering online patient encounters, find out about those too while you’re at it.

Develop a policy

Man checking into doctor's office

Meet with the other care providers in your practice, your practice administrators, office and billing staff. Develop and write a policy with regard to the types of calls that are to be billed and then stick to it. The written policy, including documentation requirements, should be included in your practice’s compliance plan. Decide how you will notify or make your patient’s aware of the new policy, and be sure to include it in any financial policy documents that are signed by new patients at registration time. Patients should be made aware that if they decline telephone care which is subject to a fee, they can always opt to have a regular, face-to-face office visit. Decide on procedures for reporting telephone care to payers, and a uniform and consistent policy for collecting payment for allowable but uncovered services.

Tips On Negotiating With Payers

Implementing a policy to charge for telephone calls sends a clear message to patients and insurers that telephone care deserves compensation. Also, it can be a less costly and more accessible alternative to office or hospital based care. Faced with demand from consumers for increased access to care, commercial insurance plans recognize the cost-effectiveness of telephone care, and many have already revised their policies to designate telephone care (and online encounters) as a reimbursable service.

  • Be specific with payers about your criteria for billable telephone care.
  • Telephone care carries with it the potential to decrease healthcare costs by providing a safe and convenient alternative to more costly face-to-face visits.
  • Like face-to-face visits, telephone care requires medical skill and judgment, and involves practice expense as well as medical liability.
  • The work components of telephone care, Chief Complaint; History (HPI, ROS, PSFH); and Medical Decision Making can meet CPT criteria for established patient office visits. This is also true for Time, when counseling is the dominant service.
  • Quality of care is enhanced when ALL substantive patient encounters are documented into the medical record. The increased documentation which would be required for telephone dare reimbursement could actually result in decreased medical liability for this type of service, and improved continuity of care.
  • Track utilization of telephone care for your practice so that you can provide payers with actual data and statistics.
  • Consistent and timely documentation of telephone calls by using a standardized encounter form such as Memo-Snap™ will establish and provide evidence that telephone care is an important and substantive method of health care delivery in your practice.

Patients, their employers, medial societies, professional organizations, IPAs, and physicians all have the ability to influence payers to revise their payment policies for these services.