12/16/2024

Oncologists Losing Revenue by Vastly Underreporting Patient E-Visits

Patient portals have allowed direct communication with oncology teams in real time – a feat that seemed impossible just 10 years ago. Although this is convenient for patients and cuts down on their need to schedule an appointment for minor questions, it can greatly add to oncologists’ workloads, seemingly without compensation.

Although the time spent on patient portal messaging may not seem billable, due to a lack of face-to-face time, the reality is that oncologists can bill most insurers for time spent on this responsibility, which is referred to as an “e-visit.” Although e-visit claims may not be among the most high-value services oncologists report, they do add up over time, and demonstrating to patients that these visits are billable can help show them that the oncologist’s time is valuable.

Data show that e-visits are vastly underreported by oncologists. One study published in April 2024, provided particularly alarming findings, noting that “UCSF Health, an early adopter of the e-visit, reportedly billed 13,000 message threads out of 900,000 total threads in the first year or about 1.5% of messages despite the evidence that much more of the message threads were likely billable.”

Every oncology practice should have a plan to bill for e-visits as they continue to increase in frequency.

Tip 1: Know the Codes
Insurers have their own detailed policies for when it may be permittable to report e-visits. For example, the Centers for Medicare and Medicaid Services (CMS) created guidelines, which stated that Medicare will reimburse the following codes:

For physicians and other qualified healthcare providers:

• 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes – Pays approximately $15.00
• 99422: …11-20 minutes – Pays approximately $30.00
• 99423: …21 or more minutes – Pays approximately $45.00

For nonphysician providers:

• 98970: Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes – Pays approximately $11.00
• 8971: …11-20 minutes – Pays approximately $21.00
• 98972: …21 or more minutes – Pays approximately $30.00

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