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Final physician payment rule keeps E/M code changes

Final physician payment rule keeps E/M code changes
November 13, 2019 Rachel Tirabassi

By Ron Shinkman for Healthcare Dive

Dive Brief:

  • CMS on Friday issued its 2020 final rules for the Physician Fee Schedule, including a streamlining of evaluation and management services (E/M) reporting that was rolled back from an earlier proposal in a change providers applauded.
  • The final rule, which is mostly unchanged from the proposed rule put forward in July, also cuts payments to physical therapists by 8% and psychologists and social workers by 7% starting in 2021. Specialty groups have decried the reduction.
  • Payments for office visits will receive a slight bump beginning in 2021. Doctors will also be paid more for treating patients with complex chronic health conditions. That new payment may be activated with a single add-on code, according to CMS.

Dive Insight:

In announcing its latest updates to the fee schedule, CMS claimed a victory in reducing the administrative burden on the nation’s doctors.

Claiming that the E/M reporting regulations are “burdensome and overly complicated,” the agency said it is cutting back on the amount of reporting medical practices have to perform. New patients will have four layers of CPT coding, compared to five for current patients, a requirement that has been retained.

The cuts are expected to save 2.3 million hours per year from what CMS calls burden reduction. They are scaled back, however, from a proposal in 2018 to entirely collapse the five layers of E/M codes.

That brought praise from the provider community.

“This new approach is a significant step in reducing administrative burdens that get in the way of patient care,” said American Medical Association President Patrice Harris. She also noted that “over the past year, the AMA and CMS worked together to achieve the first overhaul of E/M office visit documentation and coding in more than 25 years.”

The Association of American Medical Colleges also approved of the final E/M changes.

“These adjustments will allow providers to spend more time with patients and improve access to much-needed care for vulnerable patients and those with complex conditions, many of whom seek care from physicians affiliated with teaching hospitals and medical schools,” AAMC Chief Healthcare Officer James Orlowski said.

Also in an effort to cut back on red tape, the final rule allows clinicians to review and verify medical records instead of redocumenting notes.

CMS is also implementing a new Medicare Part B benefit for opioid use disorder that includes medication-assisted treatment starting January 2020. There will also be a new monthly bundled payment and new telehealth codes for treating the disorder.