Health Information Updates

Richelle focuses her practice on regulatory compliance and healthcare reimbursement. She has administrative and compliance experience in the long term care, ambulatory surgery, medical group, and private practice settings with multi-specialty providers. She is a Registered Health Information Administrator and certified professional coder with first-hand knowledge of the legal and practical reimbursement structures for government and private payors, and has assisted multiple providers in the planning, configuration, and implementation of electronic medical records.

Richelle has prepared successful appeals for WPS, RAC, and private payor claim denials, audits, and reimbursement disputes and educates providers on appropriate documentation and coding practices. Richelle has served as an expert in both privacy and reimbursement litigation matters, received national awards from the American Health Information Management Association and Health Information and Management Systems Society, and is active in local professional associations.

Richelle Marting, JD, MHSA, RHIA, CPC, CEMC, CPMA, CPC-I

Attorney, Forbes Law Group

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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