TELEHEALTH EXPEDITED ENCOUNTERS
Telehealth has made connecting with your provider easy and convenient. You don’t need to leave home and travel to a doctor’s office to receive care and staying connected is important. At RHM, we are committed to continuing to provide healthcare that is accessible, affordable, and accountable. To accomplish this, we have added several different types of patient encounters to complement your scheduled appointments. We call them Expedited Encounters because they bypass the scheduling, check in, and intake processes. Some of these Expedited Encounters will not involve direct patient contact but nevertheless will still serve as important components of your care.
These Expedited Encounters are:
As this option for care is getting more popular, you might wonder what your insurance covers when it comes to virtual options. Many insurance plans now cover the above services in addition to the scheduled telemedicine encounters. However, please reach out to your insurance provider to confirm your specific benefits. If you would like to obtain the specific codes and modifier, please do not hesitate to contact our office. We will be glad to help!
We will now go into more details about each of these Expedited Encounters.
Portal Messages Patient Encounters
When you have a medical question, sending your healthcare provider a message through the patient app or portal is one of the most convenient ways to receive your care. It doesn’t matter what time it is — or if you’re in your office or the grocery store parking lot — you can still reach out with a portal message to start a conversation with your provider. In fact, many of you are already doing this.
Consequently, the number of messages our staff have been answering has increased substantially. Portal messages that require your provider’s clinical time and expertise to answer may now be billed.
What to expect if your message is billed to insurance
For portal messages, the highest amount that you could be responsible for paying is $50. However, if your message is billed to your insurance, you may not be charged at all or you may see a low out-of-pocket cost.
The dollar amount a provider bills to insurance is based on the amount of time spent reviewing the medical records and providing advice. Providers may only bill for messages that require 5 minutes or more.
Most insurance providers cover these messages at little to no cost to the patient. If you have a deductible, or this isn’t a covered benefit on your plan, you could owe $25 to $50 for portal messages. Please reach out to your insurance provider to learn the specific out-of-pocket costs for your plan.
What messages will be billed to my insurance?
Messages that will be billed usually require your provider’s medical expertise and take longer for your provider to answer — typically taking five or more minutes for your provider to answer.
Examples of messages that will be billed:
Changes to your medications.
Changes to a long-term condition.
Check-ups on your long-term condition care.
Requests to complete medical forms.
The provider looking at your medical question might be reviewing the information you relayed and changing part of your treatment plan, or recommending you get a test to learn more. They might need to look at your medical history and do an in-depth review of your records to make sure they give you the best possible advice.
What messages will be free?
It’s important to know that not every message you send to your provider will be billed to your insurance. The quick rule of thumb is to think of time and expertise required. Does your provider need to spend a lot of time to fully answer your question? Does it require them to dig into your medical history to respond to your question?
We won’t bill for messages about:
Scheduling an appointment.
Getting a prescription refill.
Asking a question that leads to an appointment.
Asking a question about an issue you saw your provider for in the last seven days.
Checking in as a part of your follow-up care after a procedure.
Giving a quick update to your provider.
Phone Call Patient Encounters
At times, a phone call with your medical provider may be appropriate or preferred. This is to ensure that we make the best clinical decision, and you fully understand our medical recommendations. A phone call with your medical provider requiring evaluation and management will be considered as an audio-only telemedicine visit and billed according to current practices.
Radiology Interpretation Encounters
Being accessible, affordable, and accountable means that you are able to go to the imaging facility of your choice and still receive the radiology interpretation from providers who are most familiar with your case. If you wish us to, we are happy to provide you with a second interpretation of your radiology images.
Reviewing these images require your provider’s clinical time and expertise and will now be billed to your insurance. Most insurance providers cover these second radiology interpretations at little or no cost to the
patient. If you have a deductible, or this isn’t a covered benefit on your plan, you could owe $30 to $50. Please reach out to your insurance provider to learn the specific out-of-pocket costs for your plan.
Inter-professional Consultation Encounters
At times your medical condition can be complex, and your provider may want to request an inter-professional consultation with Dr. Kongoasa regarding your case. Since this is an inter-professional consultation, you do not need to have a visit with Dr. Kongoasa. This means that Dr. Kongoasa will be able to provide recommendations on your medical conditions more quickly than having to wait for an appointment to see him.
It will require your provider and Dr. Kongoasa’s clinical time and expertise to review, discuss, and come up with a management plan for you. Therefore, these encounters will be billed to your insurance. Most insurance providers cover these encounters at little or no cost to the patient. If you have a deductible, or this isn’t a covered benefit on your plan, you could owe $25 to $100. Please reach out to your insurance provider to learn the specific out-of-pocket costs for your plan.
Medical Team Conference Encounters
Once a week, we have an inter-professional medical team conference. Participants of these conferences are our physician, physician assistant, family nurse practitioner, certified nurse midwife, women’s health nurse practitioner, health coach and cycle health educators. During these conferences we discuss our most complex cases. We gather from our diverse clinical experience and expertise, and interdependently contribute to the diagnostic and treatment decisions to improve patient outcomes.
Case review, discussion, and care coordination will require staff clinical time and expertise. Hence these encounters will be billed to your insurance. Each of our participating staff will only bill if the cumulative duration from the beginning to the conclusion of the review takes 30 minutes or longer. Most insurance providers cover these encounters at little or no cost to the patient. If you have a deductible, or this isn’t a covered benefit on your plan, you could owe between $35 and $50 for each participating staff who spends 30 minutes or more on your case. Please reach out to your insurance provider to learn the specific out-of-pocket costs for your plan.
Remote Physiologic Monitoring Encounters
The ability to monitor certain aspects of your health from your own home or devices has become an increasingly popular health option. In fact, many of you are already in the daily habit of tracking your reproductive biomarkers on an app or chart. Great job! Some of you also have been utilizing continuous glucose monitoring (CGM) to help keep you better informed about nutrition and how your body responds to certain circumstances. Some physiologic monitoring systems even seamlessly download data from the monitor to its corresponding app on your devices.
Both cycle tracking and CGM are examples of physiologic biomarkers that we encourage our patients to monitor regularly. During patient visits or encounters, we routinely review these with you and take them
in consideration when coming up with a management plan. When the interpretation is done as part of your visits or encounters, your provider will not be billing additional charges.
However, at times, you may request us to analyze your chart or CGM data, and provide you with certain recommendations. Since these are not done as part of a patient visit or encounter, and require additional provider’s clinical time and expertise, we will bill these to your insurance. Most insurance providers cover these Remote Physiologic Monitoring Encounters at little or no cost to the patient. If you have a deductible, or this isn’t a covered benefit on your plan, you could owe $50 to $120. Please reach out to your insurance provider to learn the specific out-of-pocket costs for your plan.
Prolonged Non Face-to-face Encounter
Some of our patients have a complicated and lengthy medical history pertinent to their current symptoms. A better-informed medical provider will create a better plan of treatment, and taking extra time to review your medical records before and/or after the appointment is a natural course of action. A discussion with other healthcare providers caring for you currently or in the past may also be needed. Most of the time, reviewing of medical records will be done before your appointment. However, at times, we may only receive medical records after your appointment, and following the review, we may need to discuss with you any changes in the plan of treatment. When, occasionally, your medical provider need to go beyond their usual time on your current case (more than 30 minutes cumulatively), we will bill your insurance for a prolonged non face-to-face encounter. Typically, insurance providers will cover these encounters. If you have a deductible, or this isn’t a covered benefit on your plan, you could owe $100 to $200. Please reach out to your insurance provider to learn the specific out-of-pocket costs for your plan.