The stated purpose of the “virtual check-in” code is for the billing provider herself (not her clinical staff) “to assess whether the patient’s condition necessitates an office visit.” To the extent the in-person visits are rendered unnecessary by the “virtual check-in,” both CMS and the patient save money.
Here are some of the interesting highlights of the new virtual check-in reimbursement rules:
- The “virtual check-in” can be used only with an established patient of the provider.
- The permissible modality includes realtime audio-only telephone interactions in addition to synchronous, or two-way audio interactions that are enhanced with video or other kinds of data transmission. Communications exclusively by email, text, or voicemail are not reimbursable.
- To be reimbursable, the “virtual check-in” cannot relate to evaluation or management (E/M) services provided to the patient in the prior 7 days, nor can it relate to an E/M service or procedure in the ensuing 24 hours.
- Only a billing provider eligible to bill for E/M services may bill this code.
- The “virtual check-in” must be medically reasonable and necessary.
- Patients will have to pay a co-pay on this service, thus the patient’s verbal consent to the visit and responsibility for the copay must be noted in the medical record.
- The anticipated reimbursement rate will be $14 per “virtual check-in.”
For more information contact Marc I. Goldsand, Esq. at mgoldsand@cozen.com; (786) 871-3935.