In this age of Covid-19, telehealth and phone visits have been increasing significantly for everyone. Phone visits can last 20 minutes or more. Should Medicare cover a phone visit with your doctor and, if so, what should it pay?
Today, Medicare pays around $27 for a 20-minute check-in phone visit and $14 for a 5-10 minute phone visit. It could be less than what you pay a repairman to fix your refrigerator. But, believe it or not, it’s on a par with what Medicare pays for an in-person visit to a primary care doctor.
Medicare pays a lot more for evaluation and management phone visits, $55 for 5-10 minutes and $89 for 11-20 minutes. It’s also the same as what Medicare pays for the in-person visit.
In a story for Kaiser Health News, Julie Appleby asks whether Medicare should pay for these virtual visits. And, if so, should it pay as much for a phone call as for an in-person visit? To be sure, the doctors are taking the same amount of time with the patient on a call as in-person. But, is a phone call the same value to the patient as an in-person visit?
On one hand, if Medicare stops paying for phone check-ups, providers are likely to stop reaching out to patients via phone. On the other hand, if Medicare pays at the same rate as an in-person visit for these phone visits, some experts worry that doctors are likely to spend more time on the phone than needed with patients, driving up health care costs.
Some believe that Medicare should pay for the phone call but not at the same rate as for an in-person visit. That means that a “virtual check-in” would need a new billing code. And, then the question becomes how to come up with a code that deters doctors from extending the five-minute call to 11 minutes in order to get a higher fee?
Whatever Medicare pays for the visit, patients are expected to pay the 20 percent coinsurance unless they have supplemental coverage to pick up the cost.
Some doctors argue that some patients live in areas without broadband and cannot participate in a video visit. Their only alternative is a long drive to the doctor’s office if Medicare won’t cover the cost of a phone call.
But, then the question becomes whether Medicare should pay the same amount for a doctor’s phone visit as for a phone visit with the physician’s assistant or a nurse practitioner. At the moment, Medicare pays the same rate regardless of which provider is on the call.
To keep doctors from using the phone visit code too often, Medicare won’t pay for phone visits within seven days of an in-person or telehealth visit. It also won’t pay for calls with patients who need to be seen in person by the doctor.
Medicare’s coverage of evaluation and management phone visits is expected to end when the pandemic ends, most likely by next year. But, that could change if Congress or CMS decides it’s appropriate to continue paying for these calls when doctors are diagnosing and determining the best treatment for their patients. That said, virtual check-in codes are now permanent.
Here’s more from Just Care:
Leave a Reply