Taking the fear out of new codes and embracing eConsults

Insight Article

Patient Access

Coding & Documentation

Reimbursement

MGMA Staff Members
The promise of virtual care is long, but the reality of making it a profitable service line within a medical practice often is a tall task, especially when it comes to reimbursement.

Partnerships with critical access hospitals and other community healthcare organizations is one such method that University of Iowa Physicians and University of Iowa Health Care worked to implement eConsults across 16 specialties with a handle on the costs involved and the efficiencies to be gained, resulting in a sustainable new service line.

Elizabeth Jaggers, MBA, CPA, administrative director, University of Iowa Physicians and University of Iowa Health Care, said her organization had experimented with eConsults for five years and ultimately succeeded by finding pitfalls and overcoming them — from implementation and consent directives on through billing.

Jaggers will co-present “Improving the Bottom Line and Patient Access Through eConsults” at MGMA20 | The Financial Conference in Nashville, Tenn., with Katie Schaier, MHA, administrative fellow, University of Iowa Physicians. The speakers will walk through building the program from primary care out to specialists; how to build quality checks and billing checks; implementing specialist-to-specialist eConsults; and exploring the return on investment (ROI) of an eConsult program.

Jaggers notes that access metrics and time studies for providers in an eConsult program are essential in judging the ROI alongside the reimbursement to ascertain how much new revenue is realized. Being able to plan the build-out of a service line with a solid sense of that ROI is a crucial step for healthcare leaders trying to make the case for billing new codes and taking on new compliance risks.

As Jaggers puts it, it comes down to giving practice owners an answer to the question of, “why change?”

“We’re not going to dig out of costs increasing and revenue decreasing without being innovative” and trying new workflows and exploring new codes to bill such as eConsults, she said.

Schaier noted that some practices are not making sure primary care providers (PCPs) can bill for eConsults, which makes that aspect of service line development a potential differentiator for organizations that embrace it and bill for it.

But underneath all of it, making sure patients get access to specialist care is a major driver for organizations that would move toward addition of eConsults, Schaier said. Jaggers added that dermatology, in which there is a shortage of specialists in many areas of the nation, is an ideal example for developing an eConsult program that can result in lower out-of-pocket costs for patients versus a dermatology visit — all while allowing patients to get care in their hometown at their PCP’s office, prescribed to them by a specialist.

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