For many physicians, the frustration of the telephone is that they have to spend a lot of time using it, yet they don't get paid.

But it is possible to get paid for your work on the phone. It takes the right coding for the right situations, the right documentation and persistence. It also might require a willingness to bill your patients if insurers will not pay.

"Some payers are agreeing to pay for it," said Penny Noyes, president and CEO of Health Business Navigators in Bowling Green, Ky. "And it should be billed. If you bill, physicians may only get paid about 10% of the time, but if they don't bill it, they get paid 0% of the time."

Most practices provide telephone services without charge, although attempts to reduce phone time may involve cramming even more patients into a packed schedule. This is not necessarily convenient for the patient or best for a medical practice's economic viability.

"A lot of offices are full. If you can talk to a patient by telephone after hours or during the lunch time, that's good for the patient and the practice," said Sharon Bolarakis, a coding compliance auditor and educator with EthosPartners Healthcare Management Group.

Some research has indicated that 20% or more of the clinical services provided in some specialties are done over the phone. But most of the time spent on the phone with patients cannot be reimbursed, because it is considered part of a face-to-face visit, the call is short, or the insurer doesn't cover it. "These services have very specific guidelines in order to bill for them," said Betsy Nicoletti, author of The Field Guide to Physician Coding.

Insurers increasingly are willing to pay for e-mail consultations, but physicians who deliver care by telephone say voice communication offers better patient care.

"You can get more patient interaction over the telephone," said Andrew Hertz, MD, chair of the American Academy of Pediatrics' Section on Telehealth Care. "There's a role for e-mail, but the communication is more one-sided."

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