The Centers for Medicare & Medicaid Services (CMS) has made changes to payment policies, payment rates, and quality provisions this year in an effort to further streamline the process experienced by both doctors and patients.
The overall aim is to ease the burden of administrative tasks on health care providers and thereby reduce time spent on paperwork, so more time can be spent with patients. CMS hopes the final rule will improve the lives of health care providers, the access of patients to health care, and the quality of care they receive.
The changes that will affect medical billing in 2019 include the following:
Elimination of Proof of Necessity of Home Visits
Medical providers no longer need to document the medical reason why a patient must receive an in-home visit rather than an in-office visit. This will help to reduce the excess time and paperwork previously spent on this issue.
Patients who require home care will therefore be able to receive this service without further hassle. Doctors no longer have to be concerned about whether they will be compensated for the extra expenses associated with home visits.
Payment Rates Under the Physician Fee Schedule
All payments for services rendered by physicians and medical practitioners (nurses, physical therapists, radiation therapy centers, diagnostics facilities, etc.) are established under the Physician Fee Schedule (PFS), including visits, diagnostics, surgeries, therapy, and preventive services.
The new rule adds procedures that affect the calculation of payment rates. Payments will be based on Relative Value Units (RVUs), which represent the relative resources used to furnish the service.
These will serve as payment rates through the application of a conversion factor, the goal of which is to get paid separately for different services. This should ultimately improve accuracy for calculating fees and determining office/outpatient E/M (evaluation and management) codes.
Changes in Documentation
This provision removes the requirement of time-consuming re-documentation.
For established patient office/outpatient visits, practitioners may focus on documenting what has changed since the last visit. The medical provider can also focus on important changes based on the patient’s chief complaint.
There is no need for re-documentation if a careful review of the patient’s information reveals that nothing has changed.
For new patients, the patient’s complaint and history can be documented by the staff. However, practitioners should still review the documented information, update it when necessary, and indicate that a review was performed.
Future Changes in E/M Coding
CMS will implement changes to E/M coding by 2021 in an effort to reduce complications in billing and documentation. To reduce the administrative burden, physicians will have flexibility in documenting visit levels two through four, with time or medical decision-making as a deciding factor, and a reduction in payment variation for E/M visit levels two through four.
Medical Practice Billing Specialists
With the constant changes being made to medical billing requirements, outsourcing medical billing will save you from a world of stress associated with all of the coding changes and payment policies.
At ProMD Practice Management, we stay current on any changes that may affect medical billing and coding. Our highly advanced process for billing prevents medical errors – and grows your revenue in the process.
Call us today at (844) 236-5488 or request a consultation now. We proudly serve medical practices in Florida, Virginia, Pennsylvania, and Maryland, and we look forward to helping your practice reach amazing financial success.