To relieve some of the audit risk and administrative burden caused by Evaluation and Management Guidelines, CMS (Centers for Medicare & Medicaid Services) has announced they will revise the guidelines. Making changes to the 2018 Physician Fee Schedule will be a multi-year process. With change comes the potential risk of existing processes and systems to become obsolete, requiring the need to revamp your current medical billing management game plan. Consequently, once you’ve spent the time to research and implement a new plan, your bottom line will have already been reduced and damaged. Let’s discuss what these changes potentially could mean for your practice and how to best go about planning for the future.
Reasons for the changes
CMS has recognized that the guidelines are outdated and too complicated. CMS stated that they don’t detect meaningful differences between code levels, and placed an unnecessary administrative burden on providers.
Selecting or determining requirements is unnecessarily complicated. Currently, practitioners are allowed to use the 1995 guidelines or 1997 guidelines. Since they have not changed since 1997, they don’t reflect dramatic changes in technology, including EHR use. Code selection is now frequently automated, which can cause potential upcoding and challenges program integrity with the current guidelines.
What to expect
It is likely that CMS will remove many of the exam documentation and history requirements. They believe this documentation is outdated. Medical Decision Making (MDM) will be the most critical distinction in different levels of visits. The new guidelines will likely focus on eliminating the emphasis on the details of the physical exam and history and allow MDM to determine the E/M visit level.
CMS does few audits on E/M visits, but have received many complaints from practitioners about the guidelines ambiguity and administrative burden. The proposed changes will better align E/M documentation and coding with current practices. CMS is seeking input from providers and stakeholders about the proposed new guidelines. You can find details of the 2018 Physician Fee Schedule Proposed Rule here.
As an independent medical practice, how will you plan to adapt your billing processes to meet these upcoming changes? We’ve got the answer! At Recovery Specialist Inc, we pride ourselves in staying up to date with the ever-evolving healthcare industry. While you focus your attention on your patients, our team will get ahead of this change to ensure your ROI continues to increase. Higher ROI means more revenue, which in the end means the freedom to keep your practice independent for years to come. Ready to get started? Give us a call today!