Child Care :: Pediatric Telephone Care

Pediatricians may seek payment in some instances for medical advice and care provided by telephone, according to a new American Academy of Pediatrics policy statement.

With more busy and two-parent working families, and increased pressure from health care plans to improve access to care and lower costs, telephone care is a growing and important component of pediatric practice. As a result, pediatric practices are implementing new procedures to provide optimal, non face-to-face medical services outside the traditional office and hospital setting.

The new policy statement, “Payment for Telephone Care,” outlines circumstances where it may be appropriate to charge health care payers, including insurance companies and Medicaid, for telephone care and services between pediatricians and established patients.

While pediatricians should not rush to bill patients for telephone care, such care may be a billable service, if:

The care is for a new problem and does not result in an office visit within 24 hours from the time of the telephone call;

The care is for a new or existing problem for which the patient was not seen during a face-to-face office visit during the past seven days, and does not result in an office visit within 24 hours from the time of the telephone call; or

The care is related to oversight of a patient with special needs in a residential setting, and/or a patient with a chronic disease requiring physician supervision over a period of time during a given month.

Pediatricians should inform patients of the new fee and the types of calls that will be billable, some at different rates depending on the type of care, before implementing billable telephone care. Patients also should be instructed that if they choose not to use care provided by telephone, that standard, office-based care will remain available.

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults.

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