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Getting reimbursed for MyChart messages

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  • Getting reimbursed for MyChart messages

    PCP here, on EPIC. We are considering starting a standard process to bill for mychart messages more broadly (until now, it's been a case-by-case process. "Hey this sounds like something we need to bill you for. OK? Or book an appt") We have seen pages from UCSF and UVA about charging for mychart messages - basically by having a general consent before the patient sends the message that there may be a fee. I'm curious if anyone here is at UCSF or UVA or another site that bills for MyChart messages. Is it helpful? not helpful? I like the idea of getting paid for that extra work, but the pay ($25 I think) and wRVU is really poor compared to an office visit. So there's concern that we could end up with more mycharts and more low-value "nickel and dime" questions. Or people wanting to manage their chronic conditions all by mychart message. Thanks!

  • #2
    Literally starting non-F2F charges for mychart next week. Dropping the upgrade this weekend.


    • #3
      this is a thing? my wife has to answer my chart messages within a certain time period and it's just part of her job


      • #4
        Docs really need to be able to bill like lawyers, in 15 minute increments with a minimum 15 minutes at your usual rate. Thus any email or call is more like $50-100. Docs would all be happy and patients would too. But $0-25? Come on. Now it doesn't work for anyone. Docs don't want to do it and thus patients can't get a valuable service even if they're willing to pay for it.
        Helping those who wear the white coat get a fair shake on Wall Street since 2011


        • #5
          The minimum to count for an “asynchronous visit” is 5 minutes I think, over 7 days, and there is at least one longer time category. The issue is, if a 15 min office visit is a 99214, there is no way 3 mycharts are going to make you that much (to Jim’s point). To those asking how this can be done, ucsf has a good website explainer for patients. Expect your coders, compliance people, lawyers, etc to have to weigh in, so these asynchronous visits could be done much sooner than was actually implemented. And we have a very manual very optional process for charging - not sure it’s even worth the effort for what I make.

          i try to get my needy people into CCM so at least we can bill for all the nursing time. (Needy as in truly complex, or as in meeting basic criteria plus time consuming).


          • #6
            Just looked up the wrvu. Was curious.
            99213- 0.97. 99214- 1.5
            virtual check in (phone) - 5-10 0.25. 11-20 0.5; 21+ 0.75

            mychart - 5-10 min - 0.25. 11-20- 0.5. >21- 0.8

            I totally am on board for billing 6 mycharts (30 minutes) instead of 1 15 minute 99214! Burnout averted! 😀 I’m actually cautiously optimistic that getting paid for mychart could be good — but that wrvu sucks.


            • #7

              im ok with phone or video appointments

              Im skeptical about billing for my chart messages.


              It'll encourage pts to send more of these messages for cheap instead of coming for followup apts.

              Guess what admins will do?
              They'll fill up your newly empty followup slots with new patients.

              new pts generate more revenue for hospital than followups (atleast in neuro)

              More New patients , less followup slots = generates even more mychart messages, more headaches for us and more revenue for hospital,


              • #8
                My policy is if it’s more than a yes/no question then they need to come in or do a telehealth visit. My answers to these messages don’t take more than 5 min so billing that would be fraud…


                • #9
                  I tell my staff we need to make these phone calls and portal messages into appointments…


                  • #10
                    MyChart is a good tool, but my wife and I both lament the free visits/treatment patients are able to squeeze out of it. It would be awesome to be able to get some sort of reimbursement for that time and effort. It's another reason we can never fully detach from work.


                    • #11
                      Originally posted by GEAUXT View Post
                      MyChart is a good tool, but my wife and I both lament the free visits/treatment patients are able to squeeze out of it. It would be awesome to be able to get some sort of reimbursement for that time and effort. It's another reason we can never fully detach from work.
                      This. It is so easy for a patient to ask a specific question (s). There needs to be a fixed minimum charge. There needs to be an escalation as well.
                      I think it is so inefficient to require a virtual or in person visit, simply because a physician needs and should be paid. Great tool for patients and physicians (MA’s included). It works great for questions and test results and comments.
                      The physicians could have an option of waiving the minimum. I am sure there are some questions that a simple yes or no you choose is reasonable. Recent visit and a clarification. Might be that, or not.
                      I would hate to see 40 MyChart yes/no responses translate into 40 slots into 10 hours of clinic.
                      New specialty, MyChart Jockey. I’ll let you folks figure out the right compensation.


                      • #12
                        I strongly recommend making most mychart messages an appointment. I was very free with responding to mychart messages and then I had a lawsuit that in large part was due to the fact that the patient mentioned an issue maybe twice in mychart messages but never during our appointments. The messages were buried in the chart because it was a thread of messages so in epic it was filed by the date of the first message, not most recent so even with chart review between appointments I didn't see the messages to refresh my memory, I of course didn't remember given how many patients I had and the patient didn't bother to bring it up. Of course there is more to it but because of that I make patients schedule an appointment for any real concern outside of can I reschedule an appointment or refill a med or get this paperwork filled out. Just not worth it from a malpractice perspective, let alone the time suck and lack of reimbursement.


                        • #13
                          The majority of the messages to the office are for refills and "clerical" issues which are addressed by the appropriate staff, anything else gets a "what time would you like to come in or when are you available for a video visit?"

                          All the electronic correspondence is directed to the front office staff and is listed that way so there is no confusion, there is no option to email me or message me directly which solves the problem. I am completely full all day long, practicing should be at the top of the license not the bottom.


                          • #14
                            This is intriguing, but I would have concerns about some treatment situations that are discrete “episodes of care” with a beginning and end, and whether messages would be billed during the episode.

                            thinking specifically of chemotherapy cycles, radiation therapy, IVF cycles, etc.


                            • #15
                              I recently saw a new PCP. I've used Epic for years but this is the first time I've used it on the patient side through MyChart.

                              My mind was boggled by how fast I got notified with routine lab results with a link to "ask a question".