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Leaders in the medical practice setting should take note: You’ll be facing a significant series of decisions amid the transformative journey to a new E/M coding and documentation paradigm that’s soon coming your way.


Based on clues in the proposed 2020 Medicare physician fee schedule, practices that are worried about violating the labyrinthine physician self-referral rule may soon have a quicker path to guidance.


Adhere to your payers’ coverage terms to ensure your vitamin D testing meets eligibility requirements or you may fall victim to mass denials or get wrapped up in an audit.

Question: One of my payers is sending back a few dozen of our claims with the E/M codes downcoded from Level 4s to Level 3s. Is this common? Should we appeal? 

Medicare has published its 2018 patient claims data, which shows a pretty smooth rise in spending for total claims — and a bit of a spike for established patient office E/M code 99214.


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