Practice Management Alert

Question: What counts as a patient-initiated service? Can a new patient schedule one?

Oregon Subscriber

Answer: A patient-initiated service, also called a patient-initiated follow-up (PIFU), especially in the United Kingdom, is a situation where an established patient contacts the office or physician of their own accord.

Encouraging patients to initiate and arrange their follow-up appointments means they can do so based on their symptoms and individual circumstances.

“The physician doesn’t call them or contact them to see how they’re doing; that would be a physician-initiated service,” says Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California.

“It’s not a new concept,” Fletcher says. This concept goes by other names, including open access follow-up, patient-led follow-up, patient-triggered follow-up, patient-initiated appointment, supported and self-managed care and follow-up.

By definition, these visits, which may be audio-only or conducted via the patient portal, only apply to established patients. (Providers could bill for telehealth encounters with new patients with waivers issued during the COVID-19 public health emergency (PHE), but those waivers have ended.)

Make sure you’re documenting these visits carefully before you’re reporting them to payers.

“If you’re dealing with the e-visits, the portal visits, then you have to have total time cumulative on a seven-day period, and if you’re dealing with audio-only, don’t forget the definition; you can’t have had a visit within the last seven days or a related visit as a next available appointment within the next 24 hours or as soon as available. You have to really keep these things in mind when scheduling these services,” Fletcher says.