Time is money.
It’s an adage as old as time, and, in some cases, it can be literal.
Usually, physicians in the US have received most of their reimbursement through outpatient visits using a fee-for-service model. This model, which has been in use for decades now, utilizes evaluation and management (E/M) services to establish the level at which a physician can bill a patient. But now, studies have shown that physicians spend a substantial amount of time that is not reportable to the E/M system of billing, often leading to a lack of reimbursement for their time.
In addition to this fee-for-service model, PALTC practices may bill on the length of patient visits. Traditionally, time-based billing has only counted for time spent face-to-face. However, new E/M guidelines allow physicians to bill for previously unreimbursed time for patient record review, documentation, and the coordination of your patient’s care. While this clearly would lead to a spike in your practice’s revenue, it could also damage your overall productivity if you don’t manage your time correctly.
For this post, we’ll take a look at the pros and cons of time-based billing and how it could affect your practice’s overall efficiency.
Time-Based Billing and E/M Services
Since 1992, time has been included as a specific factor for many categories of E/M services. These services would consist of office visits, inpatient services, and even consultations. Times associated with these CPT codes are considered the average time spent providing a specific patient care level. For example, CPT code 99214 establishes a patient office or inpatient visit from 30-39 minutes, while other codes consist of different time intervals.
Now, you may be wondering what all counts for time-based billing services.
We know that when practices bill based on time, they usually count face-to-face time with their patients and the patient’s families. But what you may not know is that this face-to-face time includes much more than just a simple checkup. Time spent on patient history, exams, and medical decisions you may perform can all count toward the bill when using a time-based system. Other areas that are included:
- Time spent reviewing records
- Communicating with providers
- Documentation and record placement
While including these areas may seem like an opportunity to increase revenue, it can reduce productivity and care quality within your practice. This brings us to…
Pitfalls of Time-Based Billing
As we said above, time-based billing may not be advantageous for all PALTC practices. Many have noticed a correlation between productivity and time-based billing. Under time-based billing, the complexity of treatment is not considered, so you could be taking care of two patients with the same diagnosis but depending on how much time you spend with each patient determines the billing outcome. This, in turn, would make your practice less productive as you begin to spend more time on cases that may take less time than given.
Additionally, paying too much attention to the clock may affect the quality of care you provide. Each patient, new or old, requires different levels of care and attention, which makes it difficult to bill each case within a specific time frame. This often leads to a negative impact on the patient experience and your practice’s reputation overall.
As you learn more about time-based billing in long-term care, it’s important to note that not all PALTC practices are built the same; each one with its strengths and weaknesses. This leaves one final question to ask…
Which Way Should You Bill?
Traditionally, most healthcare providers utilize medical decision-making (MDM) to determine how they will bill a patient. This usually consists of patients being billed based on medical complexity instead of face-to-face time with their physician. While this form of billing can help increase practice productivity and patient experience, it’s not the solution to every problem.
In certain circumstances, time-based billing may be the appropriate answer. For new or complex visits, time is required for counseling, care coordination, chart review, and testing. This results in the need for billing on time to be fully reimbursed for the physician’s work, even when they are not sitting face-to-face with their patient.
A good rule of thumb to follow is that new visits should be based on time, while returning visits or checkups are based on MDM billing.
Time-Based Billing Wrapped-Up
If you take anything away from this post, it should be that billing is an intricate, complicated process for any PALTC practice. But no matter how you bill, it’s essential to know the ins and outs of each way. For practices still billing on MDM coding, it’s important to remember that certain visits, such as new or more complex ones, require time-based billing due to all the time spent on your patient. On the other hand, there are better options than time-based billing for some patients. Certain patients, such as returning ones, don’t require as much time as others, so billing them on time-based critique may affect your practice’s overall productivity. No matter what form of billing you use, it always comes down to the patient’s needs and comfort. But, then again, when isn’t that the case?