Association of Time-Based Billing With Evaluation and Management Revenue for Outpatient Visits

Abstract

IMPORTANCE Time-based billing options for physicians have expanded, enabling many physicians to bill according to time spent instead of medical decision-making (MDM) level for fee-for-service outpatient visits. However, no study to date has estimated the revenue changes associated with timebased billing. OBJECTIVE To compare evaluation and management (E/M) reimbursement for physicians using time-based billing vs MDM-based billing for outpatient visits of varying lengths. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used 2019 billing data for outpatient E/M codes and 2021 reimbursement rates from the Centers for Medicare & Medicaid Services. Modeling of generic clinic templates was performed to estimate expected yearly E/M revenues for a single full-time physician working in an outpatient clinic using fee-for-service billing. MAIN OUTCOMES AND MEASURES Yearly E/M revenues for different patient visit templates were modeled. The standardized length of return patient visits was 10 to 45 minutes, and new patient visits were twice as long in duration. RESULTS Under MDM-based billing, increased visit length was associated with decreased E/M revenue

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The Time Burden of Office Visits in Contemporary Pituitary Care, 2016 to 2019

“…Moreover, the claims analyzed in this study occurred before the implementation of time-based billing for E/M coding in 2021, allowing physicians to include time spent before and after visits in coding calculations. 20 This argues that E/M coding at the time of these claims (2016-19) may have been more representative of patients' experience. However, future studies evaluating time toxicity and coding practices must also consider how time-based billing may alter future results, as it has been shown that physicians with longer visits are more likely to experience higher revenue when using time-based billing than physicians with shorter visits.…”

“…However, future studies evaluating time toxicity and coding practices must also consider how time-based billing may alter future results, as it has been shown that physicians with longer visits are more likely to experience higher revenue when using time-based billing than physicians with shorter visits. 20 This could indicate that endocrinologists with longer visit times than otolaryngologists may be more likely to use time-based billing more than their counterparts with shorter visit times on average, but differences in coding practices between specialties requires future study.…”