Home | News & Analysis
Part B News
With E/M documentation guidelines getting a makeover in 2021, losing history and exam as factors means it will be more important to properly document medical decision-making (MDM) and, if you bill on time, time spent in non-face-to-face services.

The groundbreaking E/M code changes that are on track to arrive by 2021 gained clarity after the AMA released a preview of the E/M documentation guidelines you’ll use to code office visits in 2021.


Medical practices that use non-physician practitioners (NPPs) may have gotten a little nervous last month when the Medicare Payment Advisory Commission (MedPAC) proposed the end of incident-to billing. Whether CMS accepts the proposal or not, other signs are showing that the feds would like to get all NPP services reimbursed at 85% of the physician rate, regardless of incident-to status.

Question: We have a patient who received outpatient care at our hospital clinic. This patient is also currently an inpatient in a rehab orthopedic hospital. We’re getting a Recovery Auditor (RAC) investigation on our charges for the patient stating we cannot bill an outpatient physician visit while the patient is an inpatient. (Our hospital bills an outpatient code on the rehab hospital’s inpatient bill.) The hospitals are both owned by the same system. What can we do?

MedPAC may be right that the use of nurse practitioners (NPs) and physician assistants (PAs) under incident-to billing is masking the size of their contribution to care. It’s clear that even when billing under their own specialty codes, these top mid-levels are billing more than before, according to 2017 Medicare claims data, the most recent available. Overall denial rates are not great, but when you put them to work on the right service they do very well.


User Name:
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.
Back to top