Navigating e-visit billing

© plo - stock.adobe.com

In an age where digital advancement is permeating every sector of the economy, health care is no exception. Innovations, especially in telehealth and e-visits, promise to deliver health care more conveniently than ever before. While these changes hold great promise, they also present new challenges—particularly in billing.

Many primary care physicians are turning to digital communication – including e-visits, phone calls, and emails, to provide both virtual care as well as stay in touch with and receive updates from their patients. This has led to the question of how to bill ethically for virtual health care services while maintaining transparency and trust with patients.

The digital transformation of health care

Digital innovation, undeniably, ushers in an array of new tools and systems that make health care delivery more efficient. Electronic health records (EHRs), telehealth platforms, and patient portals are just a few advances that have greatly expanded the capabilities of health care organizations. Such tools not only enable real-time communication but also foster a more patient-centered approach.

However, as with any change, these tools come with a unique set of challenges. One critical area where this is evident is in how digital technology has enabled “care from anywhere” - blurring the once clear boundary around when a conversation with a patient is billable.

The double-edged sword of e-visits

For most of modern health care, physician services have been provided in-person. Phone calls and emails with patients were focused on non-care related communications such as verifying insurance, checking appointment times, or clarifying physician instructions for medication. Then, virtually overnight, the pandemic accelerated the digital transformation of care delivery. Now patients may call, email, or chat virtually with their physician rather than coming in for care.

E-visits, at their core, promise accessibility. For the elderly, those with mobility issues, or even those with tight schedules, being able to consult their doctor online is a significant boon. It reduces the barriers to accessing care.

Yet this very convenience has surfaced questions regarding cost and billing practices. As a primary care physician, how do you navigate these waters without alienating your patients or undervaluing your services?

The patient’s perspective

From the patient's standpoint, the primary concern is clarity. Patients appreciate the convenience of e-visits but are wary of hidden or surprise charges. They are accustomed to sending an email or calling their physician to ask questions without being charged as though they were receiving in-office services.

This means that physicians need to educate patients on these changes and provide clear guidelines on what types of digital communications and scenarios will be billed. Being clear about the costs upfront is crucial to helping patients understand why this change is being made. Transparency not only prevents later misunderstandings but also builds trust—a crucial component to a healthy physician-patient relationship.

Physicians' challenge: fair compensation for digital services

On the other side of the equation, physicians want assurance that their services, even when offered digitally, are appropriately valued and compensated. This sentiment is wholly valid, given that e-visits often require the same level of expertise and sometimes even more preparation.

The regulatory and insurance policies around e-visit reimbursements are always changing. It’s important for primary care physicians to keep updated on these changes to ensure they’re properly reimbursed for e-visits. The American Telemedicine Association is one resource that brings together updates from across the country on virtual health regulation. CMS also has a section on its website dedicated to telehealth related updates to help physicians stay informed.

Strategies for transparent e-visit billing

Before educating their patients, physicians need to come up with a clear set of guidelines around what types of e-visits are billable and what types of patient communication are not. These guidelines will vary from practice to practice, and factors such as insurance reimbursement, specialty, and patient demographics should be considered when drafting them.

Here are four tips for creating effective e-visit billing guidelines:

Clear communication with detailed information about charges is crucial. Before initiating an e-visit, provide patients with detailed information about potential charges. Be clear about when a call or email from a patient is billable and when it is not.

Demonstrate and explain the value of e-visits to patients. Patients might not understand the intricacies of e-visits. It is important to explain that these visits require the same level of care, attention, and expertise as in-person consultations.

Allow an open dialogue. Encourage patients to ask questions about e-visit charges. The more they understand, the less likely they are to feel blindsided by unexpected charges. The name of the game here is transparency and accessibility.

Keep your patients updated. Billing guidelines, especially around newer services like e-visits, may evolve. Stay updated with the latest regulations and best practices and communicate any changes to your patients promptly.

While the landscape of health care continues to evolve, the core goal remains the same: patient care. By approaching e-visit billing with transparency, empathy, and open communication, primary care physicians can ensure they are fairly compensated while maintaining trust with their patients. As the health care tech world continues to expand, it's vital to keep the lines of communication open, ensuring everyone is on the same page and working towards the shared goal of accessible, quality care.

Sarah M. Worthy is CEO of DoorSpace