While coders, auditors, and providers no longer need to fret over the tedious history and exam counting of yesteryears for outpatient evaluation and management leveling, the data complexity under the 2021 guidelines carries its own confusion with counting and interpreting how data qualifies across documentation.

Late last week, CMS released its annual proposed changes to the Physician Fee Schedule for 2022. The draft covers many important changes that will impact payment rules for the new year. Public comment will be taken until September 13th, and providers are encouraged to submit feedback, as this will be considered to develop final PFS policy.

In a March 9th technical correction publication, the AMA clarified several interpretation points of the 2021 Evaluation and Management guidelines. This was anticipated, and likely to continue through this year as providers challenge and question the new counting structure over medical complexity. The clarifications focused on the E/M elements and CPT definitions within the medical decision making table.

Under the National Emergencies Act, Sections 201 and 301, the Centers for Disease Control (CDC) has issued further additions to the current list of ICD-10 codes to capture more information about the condition. The new codes went into effect January 1, 2021. The CDC has developed an ICD-10 tool, free to the public (see below), to search and summarize code use and chapter guidelines. Insurance companies will be adding these to the list of usable codes, yet, each payor will likely have their own policy for specific codes relating to testing.

After the release of the Final Rule December 2, 2020, physicians across the country were feeling the pinch of a 10% reduction in the MPFS. The Consolidated Appropriations Act, finally signed into law on December 27th, modified the Final Rule terms by revising the conversion factor to $34.8931 reflecting a 3.75% increase across the board for CY 2021. The legislation also suspended the 2% payment sequestration through March 21, 2021 and reinstated the 1.0 floor work geographic price cost index through 2023. The AMA lobbied against the implementation of the complexity code (G2211) due to its ambiguous and controversial definition, the Act will delay its use now to 2024.

As the Coronavirus has started to overwhelm our physicians and hospitals, we are sharing important updates to ensure you have important CMS information in this new phase of patient care. March 17th , Seema Verma, CMS Administrator issued new guidance for billing Telehealth service. This benefit has greatly expanded with regards to technology, patient location, and HIPAA rules. Prior to this release, CMS issued a public health news alert (February 13th) announcing the new HCPCS codes to be used for testing. Here’s a summary of the latest information to share with your medical teams and billing staff.

Please feel free to reach out as we are working around the clock to ensure you have the most current resources to navigate options for patient care and billing.

As a follow-up to the November 21st webinar, we are pleased to share the complete list of questions submitted as part of the live broadcast. If you were unable to attend the webinar, you can click on the “read more” below to register and listen. Additional questions can be submitted by emailing jana.gil@gillcompliance.com.

As the Final Rule was released earlier this month, we have updated our summary to include most anticipated topics for the upcoming years. These policies will go into effect January 1, 2020, except for the evaluation and management changes scheduled for 2021.

As part of the CMS PFS Proposed rule for 2020, this summary includes most covered topics and codes utilized by our clients and subscribers. Although these policies are still in draft prior to the final rule being published early November, our abbreviated version will hopefully provide insight to upcoming changes in the physician fee schedule and telehealth approved services.

As part of an ongoing effort of CMS to streamline patient care and adopt more coverage for Telehealth services, providers will see several new coding options for CY2019.  As per the Physician Fee Schedule final Rule published November 1st, CMS approved two new HCPCS codes to address established problems when utilizing telephone or internet exchange.