After the pandemic, how much is the doctor’s phone call worth?
Maybe this happened to you recently: your doctor called you for an examination, talked for 11 to 20 minutes, maybe answered a question you contacted her office, or asked you how to cope with a medication change.
For this reason, if you participate in Medicare, your doctor will be paid about $27—maybe a little more if you have private insurance.
Behind these calls is a four-digit “virtual registration” billing code created during the pandemic, which is used to continue telephone conversations within this range, which has aroused great interest from the doctor community.
This is part of a larger and increasingly fierce debate: Should insurance companies pay for “audio only” access? And, if they do, should they pay the same reimbursement rate as when the patient sits in the doctor’s office, as allowed during the pandemic?
Some groups of doctors and other experts have warned that cutting off or reducing audio-only payments could cause providers to drastically cut telemedicine services. Other stakeholders, including employers who pay for medical insurance, worry that payment parity for audio-only telemedicine visits may result in excessive charges. For example, will it cause a lot of unnecessary follow-up calls?
Robert Berenson, a researcher at the Urban Research Institute, has spent most of his career studying payment methods. He said that if insurance companies pay too little, doctors — now accustomed to reimbursement — may not Calls to follow-up calls they should have called are free before the pandemic.
However, he added, “If you pay them what they want, at a face-to-face parity, you will run on the national treasury. The correct policy is somewhere in between.”
Although medical insurance bill codes are a dull and mysterious topic, they have attracted great interest from doctors, hospitals, therapists, and others because they are the basis of American health care charges. Medical insurance judgments can be used as benchmarks and guidelines for private insurance companies to formulate their own payment policies.
There are thousands of codes that describe every possible type of treatment. Without the code, you cannot pay. The creation of codes designed to reflect the workload involved and the determination of the amount of reimbursement by medical insurance have prompted vigorous lobbying for the commercial interests involved. The American Medical Association derives substantial income from the right to own a specific set of doctor billing codes. Other codes are established by dental groups and the Centers for Medicare and Medicaid Services or State Medicaid agencies.
The idea of ??a “virtual registration” code started before the pandemic, in 2019, when Medicare included it to cover 5 to 10 minute phone calls from doctors to confirmed patients. It pays about $14.
When the pandemic hit, Congress and the Trump administration opened larger doors for telemedicine and temporarily lifted restrictions—mainly restrictions that restricted such services to rural areas.
At the same time, CMS this year added a billing code to longer “virtual registrations” — 11 to 20 minutes of calls — set at approximately US$27 per payment, and patients bear 20% of the co-payment. Such calls are designed to determine whether patients need to come in or otherwise have a longer evaluation visit, or whether their health problems can be handled simply by phone.
The doctors argued that allowing the payment of audio-only care is a positive step for them and their patients.
“I take care of patients who drive from two or three hours away and live in places without broadband access,” said Dr. Jack Resneck Jr., a dermatologist and president-elect of the American Medical Association. “For these patients, backups are important when the video option does not work.”
Nonetheless, the focus on phone-only care has raised concerns.
“This is an invitation to convert every 5-minute call into an 11-20 minute call,” Berenson said.
The Medicare code allows “other qualified health professionals”, such as physician assistants or nurse practitioners, to pay for such calls. Private insurance companies will formulate their own rules regarding whether non-doctors can pay for follow-up calls. It is not clear how much revenue stream the use of these employees for these short telephone registrations will create for medical practice.
In order to avoid excessive use, CMS does have a rule: If you make a call within 7 days after the assessment visit, whether in person or through telemedicine, you cannot use the code. If the doctor determines that the patient needs to see a doctor immediately, the phone cannot be billed.
However, when the health emergency is over, most audio-only payments will also end. The emergency is expected to last at least until the end of the year. Congress or CMS may change the rules regarding audio-only payments, and more lobbying activities are expected.
Although virtual registration codes have become permanent, the physician community is lobbying for medical insurance to retain many other phone-only access codes created during the pandemic, some of which allow doctors to charge for phone-only access. Doctors may diagnose the patient’s condition and make Make a treatment plan.
For those considered to “assess and manage” audio visits, during a public health emergency, Medicare paid about $55 for 5 to 10 minutes of calls and $89 for 11 to 20 minutes of calls— Same access as the call in the office.
Dr. Ida Stewart, Chairman of the Board of Directors of the American Academy of Family Physicians, said: “Whether we are seeing a doctor at home, or through video or phone calls, we all need the same encoding” and the same payment because the workload involved is similar.
Suzanne Delbanco, executive director of Catalyst for Payment Reform, said that many patients like the concept of telemedicine, and the organization represents employers who want to revolutionize the way they pay for healthcare. Moreover, for some patients, this is the easiest way to see a doctor, especially for those who live far away from urban areas or who cannot take time off or are far from home.
But, she said, employers “do not want to be locked in to pay more than in the past, or as much as everyone else. [in-person] When its value to the patient is not really the same, go to the doctor. “
KHN (Kaiser Health News) is a national newsroom that provides in-depth news reports on health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating projects of KFF (Kaiser Family Foundation). KFF is a funded non-profit organization that provides information about health issues across the country.