Medicare Compliance & Reimbursement

All roads lead to burden reductions.

As the feds maintain a steady focus on regulatory reform, you may be relieved with their push to significantly cut back your paperwork. But don’t get too excited — some action points may leave you with a lot less money in your pocket.

Breaking news: CMS dropped a few bombshells in its July 12 release of the proposed Medicare Physician Fee Schedule (MPFS) for CY 2019, which is scheduled for publication in the Federal Register on July 27. The real shocker revolved around the long-promised evaluation and management (E/M) revamp.

“Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care,” said CMS Administrator Seema Verma in a press release on the MPFS. “This Administration has listened and is taking action.”

She stressed, “The proposed changes to the Physician Fee Schedule and Quality Payment Program address those problems head-on, by streamlining documentation requirements to focus on patient care and by modernizing payment policies so seniors and others covered by Medicare can take advantage of the latest technologies to get the quality care they need.”

Check Out These E/M Changes

CMS has been compiling stakeholder feedback on overhauling E/M services for a while now, but the suggested changes go way beyond dropping one of the three documentation requirements. In fact, the proposed MPFS pinpoints “a number of coding and payment changes to reduce administrative burden and improve payment accuracy” that CMS would like to implement in 2019, notes CMS’s MPFS fact sheet.

Those “historic” E/M documentation propositions that CMS presents include:

• Use medical decision-making or time for outpatient E/M versus the current guidelines.
• Give physicians the option of using time as a factor even if counseling or care coordination are part of the medical equation.
• Put re-documenting aside and let providers “focus their documentation on what has changed since the last visit or on pertinent items that have not changed.”
• Give practitioners the option of accepting data plugged in by staff instead of timely re-entering.

“CMS says this would simplify, streamline and offer flexibility in documentation requirements for these types of visits, which make up for 20 percent of allowed charges under the PFS,” indicates law firm Hall Render in analysis on its Health Law News blog. “The proposed rule changes the current system of four sets of documentation requirements and reduces it to a single set of documentation requirements.”

Important: Over the years, CMS has received public commentary that suggests “E/M codes need substantial updating and revaluation to reflect changes in the practice of medicine,” states the MPFS proposal. After numerous listening sessions this past spring, CMS designed a plan to rework the E/M, keeping EHRs in mind for the documentation standards, but also to create “new, single blended payment rates for new and established patients for office/outpatient E/M level 2 through 5 visits and a series of add-on codes to reflect resources involved in furnishing primary care and non-procedural specialty generally recognized services,” informs the fact sheet.

What this means: Some specialties will likely suffer greatly with the relative value units (RVUs) of these much-used E/M codes set at a single payment rate, the MPFS says. So instead of varying rates for the codes as their complexity increases, CMS advises in the proposal that the payments would be the same.

For example, Medicare pay for E/M codes 99211 through 99215 would be straight across the board at $93 while 99202-99205 would all equal $135, the MPFS shows in Tables 19 and 20. A “multiple procedure payment adjustment” in addition to various “HCPCS G-code add-ons” and other factors would impact the eventual end payment, with some clinicians slated for financial gain or losses depending on the specialty, the MPFS suggests.

Stay tuned for more in-depth E/M analysis in future issues of Medicare Compliance & Reimbursement.

Resource: For a closer look at the MPFS proposed rule for CY 2019, visit https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf.