Getty Images
How providers can begin billing for patient portal messaging
Organizations need to balance patient expectations and clinic expenses when billing for patient portal messaging.
Most healthcare organizations have started using patient portal messages to offer medical advice, but it's still not too common for them to bill for patient portal messages, according to reporting from Vizient completed in partnership with the Association of American Medical Colleges
The report, which also outlines strategies organizations can use to implement billing practices for patient portal messages, found that 100% of healthcare organizations use the technology to offer medical advice to patients. Another 57% allow structured eVisits over the patient portal, which the authors defined as condition-based question-and-answer exchanges.
These types of patient portal messages have become more commonplace since the COVID-19 pandemic, the report authors noted. Indeed, the patient portal's secure direct messaging function was, in ways, designed for this. Patient portal inboxes were intended to help field patient queries, keeping patients out of the clinic when possible.
The pandemic and its restrictions on certain types of in-person care took messaging to a new level. The influx of patient portal messaging comes at a cost to the health system, the report authors noted.
For example, more patient portal messaging means hospitals and health systems need to invest in more sophisticated technology solutions that can handle high message volumes and key requests like prescription refills and appointment scheduling.
Moreover, managing patient portal inboxes takes providers' time.
Citing data from the American Medical Association, the report authors said that physicians receive 57% more patient portal messages than they did before the pandemic. This means they have to spend more time managing their inboxes and fulfilling patient requests.
In recognition of those increased cost burdens, payers have started to accept billing codes for patient portal messaging. Healthcare organizations can bill for non-face-to-face, patient-initiated digital communications requiring clinical decision-making. Organizations can bill when these interactions take up at least five minutes of providers' time over a 7-day period.
But many healthcare organizations aren't billing for patient portal messages, the survey showed.
Only 25% of surveyed organizations said they bill for medical advice messages and 65% for structured eVisits. According to survey respondents, only 0.5-3% of medical advice messaging actually meets the billing criteria.
As healthcare providers dedicate more of their time to virtual consults via patient portal messaging, the report authors indicated organizations will need to support this with a more streamlined billing approach.
"As more patients adopt eVisits, health systems should develop processes that include all regulatory guidelines required for patient billing and compensating clinicians for these services in order to establish a sustainable model that recognizes the provider work involved in this method of care delivery," they suggested.
Of course, patients might not like being billed for patient portal messaging, the report authors acknowledged.
The practice might pose financial burdens or unexpected costs to patients, particularly when patient portal messaging has historically been free. When patients cannot afford or otherwise want to avoid the cost of a patient portal message, it could deter access to virtual care and potentially impact patient outcomes.
It is incumbent upon healthcare organizations to outline the rationale behind patient portal messaging fees, including the cost of the platform and the cost of provider time answering patient portal messages.
Improving billing for patient portal messaging
Foremost, healthcare organizations should consult with patient and family advisory committees to identify where patient portal messaging billing is falling short, is unclear or doesn’t fulfill patient needs, the report authors recommended.
Additionally, organization leaders should flag social determinants of health that could limit patient portal messaging access. These include poor access to IT, limited broadband, low digital health literacy, limited language interpretation services and financial constraints.
Patient portals might include a disclaimer to proactively communicate the potential for a bill following a patient portal message. This could be supplemented with more information about alternative lines of communication, such as a health system phone line.
On the provider side, the report authors said patient portals need to create a pooled inbox for multiple providers, allowing for message triage. This, plus supporting workflows to transition eVisits to telehealth or in-person visits, might reduce the burden on providers answering messages.
"By proactively addressing these challenges and leveraging patient portal messaging as a valuable communication tool, healthcare organizations can enhance patient engagement, improve care coordination and deliver more patient-centered care," the report concluded.
Sara Heath has covered news related to patient engagement and health equity since 2015.
