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Lisa Eramo, MA, is a contributing author for Medical Economics.
New ways to get paid for interacting with patients
In an age of healthcare consumerism, patients increasingly use the EHR portal to communicate with physicians.
It’s about convenience. They ask for prescription refills, request appointments, pose clinical questions, and more-all without having to call the office or come in to see a provider. Until now, physicians haven’t been able to bill for responding to these messages.
But there’s good news: effective this year, physicians can potentially report HCPCS codes G2010 (remote evaluation of pre-recorded patient information) and G2012 (brief communication technology-based service) to receive Medicare reimbursement, depending on the specific services rendered.
Here’s an example of how it would work:
A patient takes a picture of their rash or records a video of their gait following knee surgery and uploads it to the portal. The patient’s physician reviews the image or video and provides additional instructions or feedback to the patient. The physician may be able to bill G2010, provided all
other requirements for the code are met, says Nathaniel Lacktman, a healthcare lawyer at Foley & Lardner and chair of the firm’s national telemedicine & digital health industry team.
HCPCS code G2012 offers another potential portal tie-in, though this code also requires an element of synchronous communication. For example, a patient has symptoms of a cold, but she isn’t sure whether she needs to schedule an in-person visit with her physician.
The patient provides some information via the portal that the physician reviews. The physician then briefly communicates with the patient in real-time (e.g., via telephone or via a portal with audio-video capabilities) to advise whether the patient actually needs to come into the office for an in-person appointment.
The physician determines that no in-person visit is necessary and instructs the patient to call the office if symptoms worsen. The physician may be able to bill G2012 as a virtual check-in, permitted all other requirements for the code are met, says Lacktman.
Another example is a patient who remotely transmits physiologic data (e.g., blood sugar levels taken from a glucometer) to the physician via the portal. The physician reviews that data and calls the patient to discuss the results in real time. In this scenario, G2012 may potentially apply if the physician determines no in-person visit is needed.
Why these codes matter
Using the portal for these types of communications can be highly efficient, particularly when the physician uses clear protocols and care pathways, explains Lacktman. In addition to generating revenue, a benefit of asynchronous remote evaluations and virtual check-ins is that physicians may be able to care for additional patients without having to add more hours to their workday, he adds.
“These codes could reduce physician burnout and the need to double- or triple- book appointments,” says Lacktman. “Unlike traditional Medicare telehealth services, these codes have no rural geographic limitations. The patient can be anywhere, including at home. These are game-changing codes.”
However, there are some caveats with these codes. If the remote evaluation or virtual check-in originates from a related E/M service provided within the previous seven days by the same physician or other qualified healthcare professional, then the service is considered bundled into that previous E/M service, says Lacktman.
In this case, G2010 and G2012 are not separately billable, which means physicians can’t bill the patient or Medicare, he adds. The same is true when the remote evaluation or virtual check-in results in an E/M service within the next 24 hours or during the next available appointment.
Getting paid by commercial Insurers
Jaci Kipreos, CPC, CPMA, president of Practice Integrity LLC in Henrico, Va. is encouraged by these new codes but is unsure whether commercial payers will accept them. “Do they look good? Yes, Medicare is finally recognizing all of the additional work providers perform. But you’ve got to start talking to your private payers so you know what they’re going to do-or not do-for you,” says Kipreos.
She advises practices to contact the provider representative at each payer, and ask whether the payer accepts G2010 and G2012 as reimbursable codes.
If the answer is no, ask the payer whether they will allow the code to at least pass through its system and trigger a single line item denial-or whether it will it deny the entire claim. Practices can also flag these claims and review them manually after payer processing occurs.
If the payer allows the codes to pass through with a single line item denial, physicians should continue to report them-even if they receive a denial. “You need something to bring to the table,” says Kipreos. “You can’t just say, ‘I’m doing this, will you pay me?’ The payer will want to know the frequency, and there’s no way to account for what you’re doing unless you report the codes.”
Physicians can also advocate for payers to accept and pay these codes by explaining how these services improve access to timely care and ultimately reduce costs, she adds.
As with any new code, CMS will be watching G2010 and G2012 closely for inappropriate use, says Lacktman. “There’s a learning curve. I definitely recommend that practices take the time to understand these new codes and make sure they’re billing them correctly,” he adds.