Why do I see a charge on my statement when I didn't have an office visit for the date I am being charged for?

For many years physicians and doctor's offices have only been allowed to bill when services were provided to patients when they were present either virtually or in person. However the reality is that with the advent of patient portals, emails and remote monitoring combined with a coordinated effort by insurance to provide collaborative care this meant that a lot of physician services were being provided outside of the face to face visit time.

In recognition of these facts the Center for Medicaid Services has been transitioning over the past 5 years toward updates in the coding structure to allow for billing of these services which has been generally well adopted by the insurance company. COVID-19 has only hastened these changes in billing to allow for the provision of remote care. This allows patients the modern convenience of having certain services being able to rendered without a face to face visit, such as a prescription refill for example, while still allowing providers to be able to provide these services to the patient without being adequately compensated for the care provided.

There are a variety of CPT codes that are considered billable when we provide care outside of an office visit for services such as (please note this is not an exhaustive list):

new prescriptions or prescription refills
issuance of lab orders
care plan adjustments based on new results or new diagnosis
issuance of imaging or referral orders
coordination of care with other providers
review of outside or new records (or journals)
clarifications on questions for plan of care submitted via patient portals
patient portal communications that involve physician input

Please note our office requires all refills and orders to be requested at time of office visit so orders outside of a visit may or may not be approved depending on the patient's situation/concern and an office visit may be required. Prescriptions refilled as emergency authorizations only to the next visit may be issued in a supply less than 30 days per policy.

Since these updates more fully went into effect as of January 1st, 2021 many patients are seeing these new charges on their statements that they are unfamiliar with so they may think that they are being billed in error. However these new updates to billing codes for services has been accepted by the vast majority of insurance companies and are now billable services. We do inform all patients of the fact that they may be billed for non face to face services that are provided in our financial policies.

For more information about these nationwide billing changes please see the articles below issued by the American College of Obstetricians and Gynecologist and the AAFP as a summary of these changes and what is considered billable as a non face to face service (please note this again is not only correct information as of the date of publication and additional codes may now be valid and or expired since this document was published).

Managing Patients Remotely: Billing for Digital and Telehealth Services