Understanding Time-Based Billing & Maximizing Reimbursements

Margins are already thin in healthcare. It is important for hospitals and medical practices to maximize reimbursements in order to create a sustainable care model. For billing, there is a new path that brings some flexibility to how clinicians seek reimbursements.

In 2021, there was a change in the evaluation and management service guidelines which allows for time-based billing. This update includes billings for work before and after an outpatient visit. Time-based billing can be a critical piece for certain specialties which require longer office visits or consultations.

A study published in JAMA compared time-based versus fee-for-service billing. There is a great deal of variability when it comes to the length of patient visit with a standard visit varying from 10 to 45 minutes. New patient visits are often twice as long. According to the study, longer patient visits had a signification impact on billing. By utilizing time-based billing, the same practices had significant increases in revenue over the course of 12 months.

For administrators and clinicians wondering what to do, it comes down to length of visit. Know how long you are spending with patients and bill your time appropriately. A good rule of thumb I use—when care coordination or counseling accounts for 50% or more of a visit then time is a factor and should be considered in billing.

A few tips to keep in mind when deciding between time-based and fee-for-service billing.

Outpatient vs. In-patient

In the outpatient setting, only face-to-face time with the patient is counted toward overall time. Time spent reviewing records, talking with other providers and documenting the encounter without the patient or family present cannot be added. For in-patient providers, face-to-face time as well as any time spent documenting or consulting in regard to the patient can be billed.

Billing Time for Counseling

With regards to time-based billing, “counseling” has a very specific meaning. It is important to understand what time can be billed. According to guidelines, counseling can include a discussion of test results, diagnostic or treatment recommendations, prognosis, risks and benefits of management options, instructions, education, compliance or risk-factor reduction.

Eligible Providers

Time-based billing applies to physicians and APPs. Others, including nurses and medical assistants, are not eligible for time-based billing.

As with any enrollment and billing question, it is important to consult with your payor mix about the correct way you are allowed to bill. For the specific code information for time-based billing, talk with your staff internally. Or feel free to reach out to me. We can help build a program around time-based billing that maximizes reimbursement and takes into account the value of the time you spend caring for patients.

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