“At the start of the pandemic, many providers and insurers removed copays for visits because they wanted to encourage telehealth,” says Ellimoottil. “Now we have copays coming back from big insurers. Ultimately, we don’t know yet what the net effect will be for patients, providers, or payers.”
If telehealth leads to an increase in appointments, for instance, costs could go up. According to Ellimoottil’s research, the rate of secondary visits within 7 days is around 10% with an in-person visit. With telemedicine, the rate of follow-ups goes up slightly, potentially adding costs.
But, says Ellimoottil, it’s just as likely that costs could go down.
“If the patient doesn’t have to pay for transportation costs, parking, or take time off work to see a doctor, it could cost less than an in-patient visit,” he says. “But the question remains as to how appointments should be billed with telehealth.”
To understand telehealth billing, Ellimoottil says you should understand the things used in billing for in-person care. “The same considerations apply,” he says.
- The time involved in an appointment. “As the time goes up, the billing does, too,” he explains. “This has always been the case, even with in-person visits.”
- The complexity of the appointment. “The formal term here is ‘medical decision making,’” Ellimoottil says.
- The amount of data reviewed. “If a doctor is looking at an X-ray report versus the actual image, it’s less costly,” he says. “Or if they have to prescribe a medicine versus sending the patient home with Tylenol, the cost goes up.”
In Heal’s case, then, the $80 telehealth bill might have been due to the complexity of reading his CT scans and determining a next course of action, which the doctor then needed to explain to the patient.
“When I asked about the cost, they told me that the doctor spent 35 minutes preparing for the appointment, so it was billed as a full visit,” Heal says.
This goes back to the billing formula.
“Sometimes the appointment itself is short, but because a patient had an acute issue that required tests or a prescription for antibiotics, the billing level is higher,” Ellimoottil explains.
But like Heal, many patients have a hard time appreciating how the cost of telehealth might compare to an in-person visit. Is the quality of care equivalent? In some cases, yes, but many patients question that, and thus the associated billing.