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Out-of-pocket costs for patient portal messages reach $25

Although 82 percent of payers fully cover claims for patient portal messages, some patients are left with up to a $25 bill for the exchange.

It’s getting increasingly common for healthcare providers to bill for patient portal messages, and it’s leaving some patients on the hook for an out-of-pocket bill, albeit the bill is nominal.

According to an analysis from the Peterson-KFF Health System Tracker, the bill for a patient portal message can reach up to $25 out-of-pocket.

However, it isn’t common for patients to foot the bill for secure direct messages over the portal. In 82 percent of cases, the out-of-pocket patient cost for patient portal messages was $0, meaning their insurance covered the cost. Fewer than one in five patient portal message claims had any enrollee cost-sharing, the assessment showed.

This analysis was sparked by an influx of patient portal utilization, particularly the secure direct messaging function. While always a part of the patient portal, secure direct messaging became more common in 2020 when the pandemic pushed healthcare consumers to seek remote modalities of care.

That prompted the introduction of billing codes for patient portal messages.

Coding for patient portal messages

In 2020, new billing codes for patient-initiated emails came into play. Physicians and other healthcare providers can use the codes to bill patients and payers for patient emails that require at least five minutes of a provider’s time.

According to Peterson-KFF, providers can bill once per week the total amount of time spent per enrollee for a new medical consultation. Providers may not bill for emails that are related to scheduling appointments or refilling prescriptions, emails that are sent within seven days of an in-person or telehealth visit, or emails that entail follow-up after procedures.

It’s up to the payer whether these claims will come with enrollee cost-sharing.

Billing for patient portal messages is becoming common

Peterson-KFF assessed patient portal messaging claims using data from the Health Care Cost Institute from between 2020 and 2021, the most recent year for which there is data. In that assessment, the researchers determined that billing for email-based services had become more common.

Compared to baseline in January 2020, patient portal messaging claims spiked in April 2020 by nearly 350 percent, or one email messaging claim per 73 office-based evaluation and management (EM) visit claims. By June, patient portal messaging claims decreased to around 200 percent of baseline and remained steady through 2021 at one claim per every 192 EM visit claims.

The median combined patient and payer payment for these claims was $39, but they could get as high as $59. It was rare for patients to bear the brunt of these costs, the analysis showed. In 82 percent of claims, there was $0 enrollee cost-sharing. That equates to fewer than one in five patient portal messaging claims resulting in enrollee cost-sharing.

When there were out-of-pocket patient costs, the median payment amount was $25.

Differences in physician & non-physician coding emerge

As noted above, both physicians and non-physicians (including advanced practice providers) can bill for patient portal messaging. According to the analysis, different provider types bill differently, specifically in terms of messaging duration.

Patient portal messaging claims can fall into one of three different duration categories: short duration (5-10 minutes), moderate duration (11-20 minutes), or long duration (21 minutes or more).

Physician-submitted claims, which accounted for 56 percent of all examined claims, were mostly short (43 percent) and moderate duration (36 percent) claims. One in five physician-submitted claims were for long-duration codes, and they were mostly for messaging older adults enrolled in private health plans.

For APPs, long-duration claims were significantly more common than other durations, with 96 percent of claims being long-duration. This likely speaks to the division of labor in healthcare. A lot of patient outreach typically falls to non-physicians, including nurses, physician assistants/associates, and nurse practitioners.

Patients seek general advice in patient portal messages

Overwhelmingly, patients are seeking general medical advice from their healthcare providers via patient portal messages, with a third of message claims relating to an adult encounter resulting in abnormal test findings. Other common patient portal messaging topics included musculoskeletal pain, counseling, or infections (specifically acute sinusitis and upper respiratory infection).

As a result, specialty providers receive far fewer patient portal messages and submit far fewer messaging claims. The most common specialties submitting secure messaging claims include family medicine (32.6 percent), internal medicine (32.3 percent), and pediatrics (9.8 percent).

The merits of billing for patient portal messages are still being debated amidst outsized provider workloads and ballooning health payer premiums.

While healthcare providers argue that billing for patient portal messages has helped mediate some of the workload problems—and more payment may be needed to fully offset workload pressures—payers state that higher payments and volumes of emails contribute to the industry’s premium cost and healthcare spending issue.

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