Legal Law

Should your practice be billing codes for phone inquiries?

It seems that these days practices are doing more and more patient inquiries over the phone. Much of this may be due to current economic conditions and the fact that patients are trying to avoid having to come and be seen and being charged a co-pay.

Whatever the reason, doctors are spending more time on the phone these days asking whether or not they can bill CPT codes for phone consultations and get reimbursed.

Unfortunately, Medicare will not pay for patient consultations conducted over the phone. As for other payers, you will have to check with them on a case-by-case basis.

If this issue has become a big problem for your practice and is taking up a large amount of your time, you may want to consider billing your patients for this service.

Telephone services are generally billed using two sets of codes added to the CPT index in 2008: codes 99441 – 99443 are for physician telephone services, while 98966 – 98968 are for “qualified non-medical health professional” services. Again, none of these codes are covered by Medicare, but more and more private payers are beginning to reimburse this code, so it’s definitely worth checking with them to see if they’ll pay.

If you decide to bill patients for these codes, here are five things to know about these codes:

  • They can be billed only for “medical discussion” that IS NOT related to an E&M service that was provided in the last seven days and DOES NOT lead to an office visit within the next 24 hours or as soon as possible.
  • The telephone conversation must be documented by the provider who answered the call.
  • Although Medicare does not pay for these codes, both sets of codes are assigned Relative Value Units (RVUs) that you can use to help determine what rate to charge your patients for these codes.
  • The patient must initiate the call for you to bill for the service.
  • Codes are valid ONLY for established patients, in accordance with CPT guidelines.
  • If your practice is doing a significant number of phone inquiries, that revenue can add up over the course of a year and make a difference to your practice’s profits.
  • If you’re considering billing for phone inquiries, here are some tips that should help you get paid:
  • Negotiating with private payers: The key is to document every case over the course of a year in which you provided a phone consultation. The number of visits could be significant, showing that your doctors and other providers provided the service 120 times in a year. When you renegotiate your managed care contract, you can show the provider relations department for that payment the documentation that supports your 120 phone inquiries and explain that this is what you did. You can then request a payer assignment for these visits from provider relations. If a payer agrees to pay for phone inquiries, take an EOB showing the payment and show it to another payer and ask if they would be willing to match it.
  • Discourage patients from long phone calls and ask them to come in for an office visit. Most of your patients aren’t going to like the idea of ​​you billing them for phone calls in general, let alone those that only take five minutes. If it looks like a phone call is going to be long, go ahead and encourage the patient to come in for an office visit and explain that that way their insurance will pay for it instead of you having to bill them for the long duration. telephone consultation.
  • Get Paid for Growing Practice Expense: CPT codes for E&M phone services were established for a reason. If the codes are in the CPT book, you have every right to code and bill them. The key is to decide when you will bill for the phone consultation (ie 15 minutes etc) and see how your patients react as you don’t want to scare patients away but they need to understand that their time is valuable.

This is a billable service that is definitely worth looking into. You’d be surprised how many of your private payers can reimburse you for these codes. Also, if patients know they have to pay for lengthy phone consultations, they may just decide to come in and have a face-to-face visit.

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