What is E-Consult?
Access to specialty care continues to be a major challenge for patients across the country. With provider shortages and long wait times for appointments, demand continues to outpace the safety net’s ability to meet the needs of its growing patient population. To address this challenge, many health centers, systems, payers and policy makers are turning to electronic consultation and referral, or e-consult.
An e-consult is an asynchronous dialogue initiated by a physician or other qualified health care professional seeking a specialist consultant’s expert opinion without a face-to-face patient encounter with the consultant.
As the use of e-consult expands across the country, federal Medicare and state Medicaid policies have been evolving to support reimbursement and sustainability. As policies evolve, e-consult definitions are also expanding. In 2018, CMS included a definition of e-consult in its revised Medicare Physician Fee Schedule. In August 2019, the California Department of Health Care Services revised its Medi-Cal Provider Manual and telehealth policy to incorporate reimbursement for e-consult reimbursement. The Workgroup will continue in its efforts to achieve nationwide adoption of e-consult.
CMS E-Consult Definition
Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional.
Medi-Cal E-Consult Definition
E-consults are asynchronous health record consultation services that provide an assessment and management service in which the patient’s treating health care practitioner (attending or primary) requests the opinion and/or treatment advice of another health care practitioner (consultant) with specific specialty expertise to assist in the diagnosis and/or management of the patient’s health care needs without patient face-to-face contact with the consultant.