E/M Office Based Coding Changes effective January 2021
The
American Medical Association (AMA) and
Centers for Medicare & Medicaid Services (CMS) have together
achieved a
complete overhaul of the Evaluation and Management (E/M) office /
outpatient
visit codes, the first in almost 30 years, set to take effect on
January 1,
2021. This historic provision includes significant revisions to the
Evaluation
and Management (E/M) CPT code descriptors and standards of
documentation. The
goal of the revisions is to decrease administrative documentation
burden,
minimize audit requirements, as well as to ensure E/M office visit
payments are
resource-based. Documentation can now center on the way physicians
think and
care for their patients rather than checking boxes for billing
requirements.
The changes that will go into effect will initially be only for
outpatient
office visit codes 99201-99215, with the goal to expand to additional
E/M codes
in the future. It will be important for practices to understand the
upcoming
changes and plan for the impact, including software upgrades,
identification
and documentation of new procedures, training for both back office and
clinical
staff, and monitoring of claims submission to understand how well your
practice
has transitioned to the new requirements.
Below
links will allow you to get further
information on this topic :
AMA:
https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
https://www.ama-assn.org/system/files/2020-04/e-m-office-visit-changes.pdf
CMS:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched
2021
Quality Payment Program (QPP) Changes (Proposed)
While
the 2021 rule has not yet been finalized, the changes appear to be less
onerous than in previous years. A lot of behind the scenes work will be
done by the software companies going into 2021 as there are a host of
new requirements for the 2015 Edition EMR Certification. In
the meantime, here’s a look at the key provider-facing changes:
Health
Care Providers Fight Flu Toolkit
It’s likely that flu viruses and the virus that causes COVID-19 will
both be spreading this fall and winter, making it more
important than ever that ALL healthcare workers get a flu vaccine!
Whether you’re a primary care physician, nurse, pharmacist, or other
health care professional (HCP), you play a significant role in helping
protect your patients against influenza. The best available protection
is annual influenza vaccination for all patients ages 6 months and
older. Your strong influenza vaccine recommendation is one of the most
important factors in patients accepting the vaccine.
This page provides tools to prepare your practice to fight flu. The
materials will:
• Equip you to make strong influenza
vaccine recommendations
• Facilitate productive conversations
with your patients
• Improve your influenza vaccination rates
To read the
full
article click
here
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Are
you prepared to make the switch to Value-Based Reimbursement?
Transforming
to
a valued-based reimbursement model has changed the way providers
regularly bill for care. It is now imperative that instead of billing
for the quantity of services provided, that providers bill for the
quality of care they deliver. Providers and health systems
risk
financial penalties and lower reimbursements if they do not
successfully participate in this switch.
What
are the benefits of switching to a model focused on Value?
1.
Improvements in quality, fostered from a patient centered approach to
care
2. Promote proactive care rather than reactive care
3. Drives improvements in care at a reduced cost
4. Financial incentives; increasing the number of
ways
providers can get paid for the care they deliver
5. Improve patient experience with quality and
satisfaction
6. Enhanced population health by focusing on health
outcomes, morbidity rates, and disparities in care
How
can I
successfully switch to a model focused on Value?
1.
Meet
quality standards while cutting cost
2. Create a team-based approach to care
3. Continuously monitor data using population
health
management tools and resources
4. Ongoing education and training on
population
health, quality measures, and valued-based reimbursement programs
5. Coordinated Care that is evidenced
based to ensure
efficient and effective care across all health care systems
6. Implement and monitor quality
improvement plans
How can we
help?
FocusMD Inc
is
dedicated to supporting medical providers and regional
hospitals as they strive to deliver quality and cost-effective care to
their patients.
Our team offers Population Health Management (PHM) consulting along
with implementing various quality care initiatives.
Our team also provides services to manage and maximize reimbursements
from value-based reimbursement programs.
To receive more information about the services we offer and the many
ways we can help your organization, please reach out to us at
412-428-7700, option 1
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