Health Information Updates

Medicare Physician Fee Schedule 2020 Proposed Rule

Medicare released the 2020 Proposed fee schedule yesterday; still hot of the press and won’t be published in the federal register for 2 more weeks, but I went through it and summarized some of the most significant changes. I thought this may be of interest to NHIMA members.

A few major topics addressed:

  • Medicare scraps the “blended payment” for office visits
  • Relaxes many supervision requirements
  • Recommends several new care management codes

Post Your Chargemasters to Avoid CMS Penalties (October 8, 2018)

Part of Medicare’s 2,500 page IPPS Final Rule includes a reminder that hospitals must post their chargemasters on their website. While this requirement is already in effect, Medicare issued new guidance effective January 1, 2019.

Listen to Richelle’s explanation of these requirements

2019 Physician Fee Schedule Final Rule (November 1, 2018)

Significant changes to E/M documentation and payment, some going into effect in 2019 and others in 2021.

E/M Payments

  • 2021: Office visits will have a single, blended payment rate for levels 2-4 for both new and established patients. All other code categories remain the same
  • 2021: Levels 2-4 will have the same wRVU values
  • 2019: Two new G codes for services to determine if a patient needs to be seen for an office visit

E/M Documentation

  • 2019: Chief complaint, HPI can be recorded by ancillary staff just like ROS, PFSH
  • 2019: History, exam don’t have to be re-recorded if they’re documented on a previous visit
  • 2019: 1995, 1997 guidelines still apply as sole factor to determine levels of service
  • 2021: In addition to 1995, 1997 guidelines, providers can determine level of service with medical decision-making only (regardless of new/established patient and regardless of levels of history, exam) – but applies to office visit codes only
  • 2021: Alternatively, can select level based on time, but doesn’t require > 50% be spent on counseling coordination of care. However, different time applies due to new blended payment rate

Listen to Richelle’s recorded overview of the changes

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