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Can You Get Paid for Reviewing Patient Records? What You Need to Know?

Healthcare professional forums are revealing a billing opportunity many practitioners didn’t know existed. One physician summed up the discovery perfectly: “Just learned about it today, thanks! I definitely could have used it when I was young and picking up a lot of new complicated patients.”

The discussion centers on CPT code 99358 – a time-based code for prolonged evaluation and management services that can be billed for extensive record review performed after the date of service. Healthcare professionals are asking critical questions: “Does anyone use this code to review the stack of records you get sometimes with no time to review on the day of visit?”

The Hidden Revenue Opportunity in Record Review

99358 represents prolonged evaluation and management service before and/or after direct patient care, first hour. Healthcare professionals explain: “This is a time-based CPT codes for non-face-to-face prolonged care services. These codes may not be used on the day of an Evaluation and Management (E/M) service, such as an office visit or hospital service.”

The practical application becomes clear when practitioners receive extensive outside records: “Or when outside records are requested and you get a stack of records?” The code addresses a common scenario where thorough chart review simply cannot happen during the patient encounter.

The Documentation Requirements Healthcare Professionals Need

Forum discussions reveal critical documentation elements. One physician provided comprehensive guidance: “Document the exact time spent and the specific work done. Tie the work to the patient’s diagnosis and management plan. Don’t bill if time is under 31 minutes.”

A detailed documentation example shared in the discussion demonstrates proper structure:

“I personally spent 45 minutes today in non-face-to-face prolonged evaluation and management services for this patient, related to their upcoming outpatient follow-up visit. Activities performed: Reviewed over 200 pages of outside hospital records from recent admission for diabetic ketoacidosis and sepsis. Analyzed lab trends, including HbA1c, renal function, and electrolytes, in preparation for insulin regimen adjustment.”

The medical necessity component requires explicit justification: “The patient has multiple chronic conditions (Type 1 Diabetes Mellitus, CKD, CAD) that significantly increase complexity of care. Prolonged record review and coordination were required to ensure safe management and continuity of care.”

Key Billing Parameters and Reimbursement Rates

Healthcare professionals identified important billing thresholds: “You must spend at least 31 minutes to bill 99358.” The code structure includes 99358 for the first hour and 99359 for each additional 30 minutes.

Reimbursement rates discussed in forums show substantial value: “1.8 RVUs, nice!” with Medicare reimbursement “around $120-$130” for 99358 and “around $60-$65” for 99359. Private insurers typically pay higher rates.

One physician asked the practical question many practitioners consider: “Does that mean we can use this to review records less than 1 hour? Is there a co-pay/cost to the patient?” The answer confirms that 31 minutes minimum qualifies for billing, though the full hour designation applies to the code.

The Medicare Limitation Challenge

A critical limitation emerged in forum discussions: “Not valid for Medicare.” This restriction significantly impacts which patient encounters qualify for 99358 billing, requiring practices to verify payer eligibility before dedicating time to extensive record review with billing expectations.

For Medicare patients receiving complex care requiring extensive chart review, practices face the challenge of providing thorough service without corresponding reimbursement. This creates pressure to either rush record review or absorb the cost of comprehensive care coordination.

Commercial payers vary in coverage policies: “Many private payers also cover, though policies vary. Some require prior authorization or have limitations.” Healthcare professionals must navigate payer-specific requirements while managing clinical demands.

Workflow and Logistics Implementation Questions

Practitioners raised practical implementation concerns: “How does it work with logistics if you do? Do you have front office schedule a visit and then chart/code on that visit? Do you notify the patient before hand?”

The workflow complexity centers on coordinating billing for services performed on different dates than face-to-face encounters. Documentation must clearly connect the non-face-to-face work to related E/M services while meeting time-tracking requirements.

One physician requested specific implementation guidance: “Care to share?” seeking the documentation templates and workflows that make 99358 billing operationally feasible. The response promised: “I will have to dig it out from one of the coders when I am at work tomorrow.”

The delivered template emphasized critical elements: “The total face to face time and non-face to face time spent on this encounter date was X minutes and excludes any time spent in the performance of other services separately billed. Total # of minutes has to be stated.”

Activities that qualify include: “counseling, placing other, education. Exam, preparing for visit, communicating results and care coordination” with exclusions for “clinical staff time, travel time, separate reportable services.”

Virtual Medical Scribing: Maximizing Documentation Efficiency

While 99358 addresses billing for record review time, healthcare professionals are discovering that virtual medical scribing specialists dramatically improve documentation efficiency and billing accuracy.

Virtual scribes handle chart preparation, comprehensive documentation, and EHR management – freeing physician time for direct patient care while ensuring thorough record review is properly documented for billing purposes. When extensive outside records require review, virtual scribes can organize materials, highlight critical findings, and prepare summaries that physicians can quickly verify.

For complex cases requiring 99358 billing, virtual scribes document the exact time spent on record review, catalog specific activities performed, and ensure medical necessity justification meets payer requirements. This systematic approach addresses the documentation challenge: “Do you have to write a Note to get reimbursed?”

Healthcare professionals with medical backgrounds including Medical Doctors, Nurses, and PharmDs understand clinical workflows and documentation requirements. Based in India and Pakistan, with companies also sourcing talent from the Philippines, these specialists provide expertise at starting rates of $9.50/hour – under $2,000 monthly versus $4,500+ base salary plus payroll costs and benefits for local staff.

HIPAA, SOC 2, and ISO 27001 compliance provides enterprise-level security for patient data, while healthcare-specialized training ensures documentation meets billing requirements.

Revenue Cycle Management: Capturing Previously Unbilled Services

The 99358 discussion reveals a broader problem: healthcare practices frequently provide extensive services without corresponding billing. One physician’s response – “Just learned about it today” – suggests thousands of hours of billable work go uncompensated.

Virtual revenue cycle management specialists identify billing opportunities practices miss, ensure proper coding for complex services, and manage payer-specific documentation requirements. When practitioners spend significant time on record review, care coordination, or treatment planning, RCM specialists ensure these services are appropriately captured and billed.

For 99358 specifically, virtual RCM teams verify payer eligibility, track time documentation requirements, submit claims with proper justification, and manage any denials or requests for additional information. This systematic approach converts previously unbilled physician work into legitimate revenue.

Healthcare professionals often hold advanced degrees including U.S. licensed Pharmacists and overseas MHAs, combining clinical understanding with billing expertise. Fixed pricing starting at $9.50/hour provides transparency versus percentage-based fees that increase with collections.

Medical Billing & Coding: Navigating Complex Time-Based Codes

Time-based codes like 99358 require precise documentation and coding expertise that many practices lack. Virtual billing and coding specialists ensure:

Accurate time tracking that meets payer requirements – “Total # of minutes has to be stated”

Proper separation of billable activities from excluded time – “excludes any time spent in the performance of other services separately billed”

Medical necessity justification tied to patient diagnosis and management

Payer-specific submission requirements and prior authorization when needed

For practices discovering 99358 for the first time, virtual coding specialists review historical charts to identify cases where the code should have been used, implement documentation templates for future billing, and train clinical staff on proper time tracking.

The cost savings prove substantial: under $2,000 monthly for full-time virtual billing support versus up to $6,000 monthly for local staff with salary, payroll costs, and benefits. Healthcare-specialized professionals with medical backgrounds ensure accurate coding that maximizes legitimate reimbursement while meeting compliance standards.

Stop Missing Billable Record Review Time

Healthcare professionals are discovering billing opportunities for work they’re already performing. Instead of absorbing the cost of extensive chart review and care coordination, practices need systems that capture and bill for these services properly.

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No more discovering billing opportunities years too late. Get expert support that ensures you’re compensated for the comprehensive care you provide.

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What Did We Learn?

• Time spent reviewing outside patient records may be billable when documented correctly.

• Many providers don’t realize that non-face-to-face work can generate revenue if it meets time and medical necessity requirements.

• Documentation is key: total minutes, specific activities performed, and justification tied to patient care must be clearly recorded.

• Not all payers reimburse for this service — Medicare excludes it, but many commercial insurers do.

• With the right workflow and support (e.g., virtual scribes or RCM specialists), practices can capture revenue they’ve been leaving on the table.

What people are asking?

1. Can physicians bill for reviewing patient records outside of a visit?
Yes, in many cases. Certain payers allow billing for non-face-to-face time spent reviewing extensive outside records, as long as documentation requirements are met.

2. How much time must be spent for the work to be billable?
You must spend at least 31 minutes on qualifying activities for the service to be billable. Less than that does not qualify.

3. Does Medicare reimburse for this service?
No, Medicare does not reimburse for non-face-to-face prolonged services. However, many commercial insurers do, though policies vary.

4. What documentation is required?
Providers must document:

• Total minutes spent

• Activities performed (e.g., reviewing outside records, analyzing labs, preparing for visit)

• Medical necessity (why the review was essential for patient care)

5. Can this be billed on the same day as an office or hospital visit?
No, this service cannot be billed on the same day as an in-person Evaluation & Management (E/M) encounter. It must occur before or after the face-to-face visit.

Disclaimer

For informational purposes only; not applicable to specific situations.

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About This Blog: This Blog is brought to you by Staffingly, Inc., a trusted name in healthcare outsourcing. The team of skilled healthcare specialists and content creators is dedicated to improving the quality and efficiency of healthcare services. The team passionate about sharing knowledge through insightful articles, blogs, and other educational resources.