Boost Virtual Care Payup by $15 for Emails, Appointment Checks

Getting your practice back on firm financial footing post-lockdown will take more than just calling patients to reschedule canceled appointments. Although the U.S. is reopening, many patients still don’t feel comfortable visiting your practice, unless they absolutely have to.

What’s the long-term solution?

More virtual services and non-face-to-face care into your practice workflows may be the answer. You might just find that you’ve been providing some of these services all along—but have overlooked that you can be paid for them. Considering you can be reimbursed up to $14.80 for each virtual check-in (CPT code G2012) — figuring out how to accurately code and bill for these services can be really worth it.

Below, you’ll find some virtual care options that can boost your revenue at the time you need it most.

Tip: Telehealth is a virtual service, but not all virtual services are telehealth. Accordingly, you should not use a Place of Service code 02 (Telehealth) or modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) when billing for these services.

E-Visit Digital Communications

E-visits are intended to be short term. CPT defines them as “patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.” Unlike telehealth exams, clinicians who aren’t eligible to bill E/M codes CAN provide e-visits.

There are three sets of e-visit codes that describe communications with a patient via your portal or secure email and are reimbursable. You’ll determine the correct coding family based on the person who performed the service or assessment. Here’s how:

Physicians and qualified health providers (QHPs) who are eligible to bill E/M codes:

99421: Online digital E/M service, for up to seven days, cumulative time during the seven days of 5-10 minutes (pays $15.50)
99422: … cumulative time of 11-20 minutes (pays approximately $31)
99423: … cumulative time of 21 or more minutes (reimburses approximately $50)

Clinicians who are NOT eligible to bill E/M services (notice they use the word “assessment” instead of “E/M” is used):

G2061: Online assessment and management, for up to seven days, cumulative time during the 7 days; 5-10 minutes (pays $12.27)
G2062: … cumulative time of; 11-20 minutes (pays $21.65)
G2063: … cumulative time of 21 or more minutes (reimburses approximately $33.92)

Public health emergency (PHE) COVID-19 waivers:

Extend platform: The original code descriptions state that you may only provide e-visits via a patient portal. However, during the PHE, CMS is providing flexibility with the platform used.
Count new patients: The 2020 Medicare Physician Fee Schedule requires that a patient must be “established” to bill for an e-visit. During the PHE, considers new patients as eligible for e-visits.

Tip: Be sure to document the patient’s written or verbal request for the e-visit, including the reason for the request. Since e-visits must be patient-initiated, this documentation will help you support your reimbursement in the event of audit.

If you want more details on documentation requirements, allowed technology, and RHC/FQHC virtual codes that CMS now pays at higher rates through 2020, reserve your seat for the online training “Get Paid $23/ea. for New Patient COVID-19 Testing With 99211” from coding and billing expert, Brenda Edwards, CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC, CRCS, CMCS.

Virtual Check-In Dos and Don’ts

You may bill for another type of virtual service –a virtual check in – that uses various forms of real-time communication for a short, patient-initiated communication with their provider. You can receive almost $15 per service based on the 2020 Medicare Physician Fee Schedule.

When billing for virtual check-ins, use the following CPT codes:

G2012: 5-10 minutes of medical discussion. CMS intends you to use code G2012 to determine if an in-person appointment is required. (reimburses approximately $15)
G2010: Remote evaluation of recorded video and/or images including interpretation with follow-up with the patient within 24 business hours (i.e. the patient sends their dermatologist a picture of a rash) (pays $12.27).

In order to utilize the above codes, the services you provide must meet these requirements:

Medium: Virtual check-ins can be provided by phone, video, or other image
Patient type: Use only with established patients
Eligible providers: Billing provider must be able to report E/M services
Unrelated pre-requirement: Check-in must not originate from a related E/M service provided within the previous seven days
Unrelated post-requirement: Check-in must not result in an E/M service or procedure within the next 24 hours or the soonest available appointment which means the next opening.