MyChart Medical Advice Messages – FAQ

MyChart Messaging is great for patients to use to address simple questions about their care. However, in the past decade we have seen a dramatic increase both in the volume and level of complexity of the messages sent to our providers -- in 2022, more than two million messages were received.

Starting July 17, patient-initiated MyChart Messages may be billed to insurance as a Medical Advice Message if it is regarding a new health concern or change in patient condition that requires a provider to spend more than five minutes reviewing medical records and providing a treatment recommendation. Copays and deductibles may apply.

By introducing this new standard, we hope to reframe the types of questions patients send via MyChart and ensure our providers have the appropriate time to spend on responses. Quick questions like appointment scheduling, prescription refills, and health updates will continue to be free for staff to respond to.

What It Is

How are Medical Advice Messages different from MyChart Messages? Who determines if a message qualifies?

Both types of messages will come to the provider’s In Basket however, providers now have the opportunity to determine if the work required to respond to the message requires medical expertise AND more than five minutes of their time. At that point, a provider may convert the routine MyChart message into a Medical Advice Message, and the patient’s insurance will be billed for the provider’s work. Examples of the provider activities that could qualify the MyChart Message as a Medical Advice Message include:

• Providing a diagnosis
• Assessing a new issue or symptom
• Adjusting medications
• Chronic disease check-ins or changes in a chronic condition
• Changing a treatment plan
• Referring to services, testing, or imaging
• Other complex medical advice that requires more than five minutes of the provider’s time

Messages that do not fit the criteria above (i.e. non-urgent, simple messages about existing problems) remain as routine MyChart Messages and will not be billed.

What types of messages can NOT be converted to Medical Advice Messages?

Health systems across the country that have launched similar programs have found that less than 3% of messages are billed. Messages that should not be billed include:

• Scheduling appointments
• Requesting prescription refills
• Asking about an issue addressed by the provider within the last seven days, including in-person or on-demand video visits
• Patients giving a quick update about their health
• Questions about most lab and imaging results
• Messages that only take a few minutes to answer
• Behavioral health concerns

Why is UR Medicine doing this?

• Originally, MyChart Messages were intended to ask simple questions about care for a quick reply. Over the years, messages have grown in volume and complexity, impacting provider wellness as they apply their due diligence in addition to tasks performed in clinic. Introducing the ability to convert MyChart Messages into Medical Advice Messages offers providers a new mindset on tackling In Basket communications: by acknowledging that this work uses their clinical expertise and valued time.
• Insurance companies now cover costs associated with video visits, telephone visits, and medical advice messaging through MyChart in addition to in-person visits. This new billing model not only compensates providers for performing clinical tasks prompted by patient messages, but also tracks and categorizes the type of digital care that providers spend time on.

Patient Impact

What if a patient doesn’t have insurance or can’t afford the copay?

UR Medicine offers financial assistance to insured and uninsured patients based on income and personal circumstances. Learn more.

How will patients be notified that their message might incur a charge?

We are using a variety of notification methods to alert patients about this new process. All notifications will include a link to our website with information about billing practices. The notifications include:

• The patient’s MyChart landing page will have a prominent box that explains the new change.
• Patients will receive an additional pop-up message in the MyChart Message box, alerting them of our new approach. Proceeding to the next step acts as confirmation that the patient understands and accepts that their insurance may be billed in regard to their message.
• Patients will receive a smartphrase message from their provider if a response to their message required more than five minutes of the provider’s time and expertise, resulting in a possible charge to their insurance.

Will patients consent to Medical Advice Messages?

Yes, by studying other health systems that have introduced this model, UR Medicine expects most individuals in our patient population to be willing to consent to potentially incurred costs to receive health care services. As we adapt and grow in this new chapter of digital health care and communications, we do not expect cost to significantly deter patients from sending messages.

What if the patient’s message is too urgent for a medical advice message?

The MyChart messaging screen reminds patients to allow up to two business days for a response. They are also advised to call the clinic if they have urgent problems that need a faster reply, and to call 911 or go to the nearest hospital for emergencies.

How will patients know if their message was answered as a Medical Advice Message?

When a provider converts a routine MyChart message into a Medical Advice Message, they must use a specific smartphrase when responding. The smartphrase clearly outlines that the exchange may be billed to their insurance, and why. The smartphrase -- .MEDICALADVICEREPLY -- also includes a link to our website for the patient to read more information about this process. Finally, “Medical Advice Message” will be listed in the patient’s past appointments on both MyChart and their billing statement.

Will this raise health care costs? Is this equitable?

We believe most MyChart messages will NOT be billed to our patients, as similar health systems that have launched this model have reported that less than 3% of message responses are billed to patients’ insurance. For billable Medical Advice Messages, most patients can expect a small charge to their typical copay or deductible. The charge is typically lower than in-person and virtual visits.

Could this harm communication with the care team?

Our intention is not to reduce patients’ communication with providers but rather to ensure providers spend appropriate time reviewing and responding to complex messages and are compensated for the care they provide. UR Medicine will closely monitor the types of messages that are billed and will adjust policies if we detect trends showing inequities or barriers to care.

How will we be tracking patients’ reactions to this change?

Our teams in Patient Relations, Billing Help Desk, and MyChart Help Desk will be coordinating with URMFG to monitor trends. We want to hear from you if you are hearing complaints as well.

Finance and Insurance

How much are patients charged for MyChart Messages?

Unfortunately, due to differences in the complexity of messages, how much time is spent by the provider, as well as variability in patient insurance plans and deductibles, we cannot give a precise estimate regarding out-of-pocket costs for Medical Advice Messages. We have included links on MyChart to our website with helpful information about what Medical Advice Messages are, what qualifies, and typical costs depending on insurance. Here are examples of common cost scenarios:

Can a charge be removed or converted back to a regular MyChart Message?

The first time a patient disputes a charge for a Medical Advice Message, the Billing department will waive the fee and educate the patient that they will be charged for future messages they initiate if they require medical expertise and five or more minutes of the provider’s time.

Billing department staff: please refer to the latest training material or speak with your manager about procedures for removing a charge.

Exclusions and Exceptions

What about Worker’s Compensation, Veteran’s Association, and Motor Vehicle Accident care?

These types of care need to be pre-authorized and should NOT be billed as Medical Advice Messages.

Can messages concerning mental health care be converted?

Questions about mental health services and care should NOT be billed.

If a provider initiates a message to the patient or plan of care, can that message be converted? 

No, the patient must initiate the message for it to be billable as a Medical Advice Message.

Can Medical Advice Messages be completed in languages other than English?

Unfortunately at this time, we do not have a way to automatically translate any MyChart messages, including Medical Advice Messages. If you are unable to communicate with the patient in their preferred language, the message does not qualify for billing.

In the Spanish version of MyChart, we advise patients to call the clinic with questions using interpreter services, if necessary. Providers and office staff may also advise patients to call by using the smartphrase .MYCHARTSPANISH to respond to patients who prefer Spanish as their primary language.

Can we bill pediatric patients age 14-18?

No, we cannot bill if the provider is talking to a pediatric patient directly without the parent or guardian. Messages concerning pediatric patients may only be billed if a parent or legal guardian age 18 or older initiates a MyChart message on behalf of the child.

If a family member sends a MyChart message on behalf of an adult patient, can that message be converted?

No, billing applies to messages that are between the provider and patient directly.

Questions and Comments

Who should I talk to about billing questions and feedback to Medical Advice Message?

SMH, Highland Hospital, and Professional Bills
General: (585) 758-7650 or 1-888-925-4301
Financial Counseling/Case Management: (585) 275-2273
Monday – Friday 8:00 a.m. to 5:00 p.m.

MYCHART MEDICAL ADVICE MESSAGES – PROVIDER FAQ

Making the Decision

Who is responsible for converting a regular MyChart message into a Medical Advice Messages?

Physicians (MDs, DOs), nurse practitioners, physician assistants, optometrists, and certified nurse midwives can make the decision to convert a routine MyChart message into a Medical Advice Request.

How do I get credit for completing a Medical Advice Message?

You may earn RVUs, valued at three levels of ICD codes and based on the range of time committed to addressing the patient’s need: 5-10 minutes, 11-20 minutes, and 21+ minutes.

If an APP covers a physician’s In Basket, answering messages on their behalf, who receives the RVU credit?

The APP will be credited for converting the message to a Medical Advice Message, as they will be the one to sign off on the task.

Can fellows convert messages into Medical Advice Messages?

Not at this time.

Following the Workflow

How does this change my workflow?

Once you determine that an In Basket message qualifies to be a Medical Advice Message, you may select the message and click the “Medical Advice Message” button from the top In Basket menu. eRecord will open an e-visit summary view showing the patient information and current message thread. Upon completing applicable tasks, you may Sign Visit and will be prompted to complete a note template that includes a disclaimer to the patient that this interaction may incur a charge to their insurance. Once the note is sent, the E-Visit Status section of the next view allows the provider to indicate how much time the tasks took to complete.

When replying to a patient, do I need to respond as a Medical Advice Message from the start, or can I do so later if more information or clinical concerns arise in the conversation?

You can make the decision to reply as a Medical Advice Message at any point in a MyChart Message chain if it is appropriate.

If there are additional needs from the patient after the Medical Advice Message is signed as completed, what should I do?

You may continue to reply to the patient in the message chain, if appropriate. If this increase in time spent on the issue is within seven days of initiating the Medical Advice Message, you may change the level of service to reflect the increased amount of time (however you must also update the encounter note to reflect the updated time spent).

Should subsequent messages on the same topic be billed?

Only new, complex messages that take the provider’s time and medical expertise to respond to, including detailed reviews of the medical record, adjustments to the treatment plan, or referrals to additional services, may be billed. If the message is about the same topic within seven days, there will not be additional billing.

Is there a response time limit associated to messages that can be billed?

Yes – only those messages that are responded to within two business days are eligible to be billed. Additionally, messages regarding a concern addressed within seven days of an in-person or telehealth visit should not be billed.

7/6/2023

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