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E/M overhaul will necessitate careful study, preparation, expert says

08/17/2020

To understand the significance of the E/M updates contained within the proposed 2021 Medicare physician fee schedule, Part B News touched base with revenue cycle and practice management specialist Cathy Archuleta, CPC, manager with SunStone Consulting in Harrisburg, Pa.

QPP updates in 2021: Changes to measures, easier performance threshold, no MVP

08/17/2020

by: Roy Edroso

The Quality Payment Program (QPP) is slated to retrench slightly due to COVID-19, but take note of several big news items: You’ll find a new reporting scheme for MIPS Alternate Payment Models (APM), a smaller-than-expected rise in the overall performance threshold and several telehealth innovations.

Code and fee preview: Take a first look at the code changes coming your way in 2021

08/17/2020

by: Julia Kyles

Coders will have a small set of new procedure codes to juggle while they adjust to the new system for coding E/M office visits. Here are some highlights gleaned from the proposed 2021 Medicare physician fee schedule. See the chart, p. 10, for a preview of projected payments based on the proposed relative value units (RVU) and conversion factor.

New APM Pathway has downsides, and poor scores can mean a quick exit

08/17/2020

by: Roy Edroso

CMS is giving providers in the Shared Savings Program a potentially problematic new quality reporting mechanism and a two-strikes policy for underperformers.

In E/M watershed year, most specialties projected to take a reimbursement bath

08/17/2020

by: Roy Edroso

The extraordinary redistribution of allowable fees within the physician fee schedule is on pace to produce some crooked numbers in 2021. The payment outlook appears grim for a number of specialties whose reimbursement on top codes CMS proposes to reduce dramatically. Yet some specialties will still see gains.

CMS proposes 11% cut to 2021 conversion factor, confirms E/M coding overhaul

08/10/2020

by: DecisionHealth staff

You can expect to see wild swings to Medicare pay rates in 2021, according to proposals CMS released August 4. The agency announced a nearly 11% cut to the Medicare physician fee schedule’s conversion factor (CF), dropping it to a rate of $32.26 next year, down from $36.09 in 2020.

Accelerated payments coming due could pinch providers; feds slow about giving relief

08/10/2020

by: Roy Edroso

Some of the tens of billions of dollars in advance payments CMS used to help providers in the early days of the COVID-19 crisis are coming due, and though Congress has made some moves to address this they’re moving slowly. Major medical organizations are pushing them and CMS to act.

Use the fee schedule’s addendum B to winnow out procedures unsuited for the office

08/10/2020

by: Julia Kyles, CPC

Question: Do you know where we can find a list of procedures that are allowed in an office setting?

Lesion removal, blood draws top list of non-E/M codes in the office

08/10/2020

by: Richard Scott

Of the millions of procedures performed in place of service (POS) 11 (Office) every year, lesion-destruction services are some of the most frequently reported. Debriding nails and joint injections are other common non-E/M services.

How to craft provider contracts that deal with board sanctions — and protect the practice

08/03/2020

by: Roy Edroso

When setting up employment or partnership terms for providers, practices usually make some provision for medical board actions that would render the provider’s presence unsustainable. Experts say practices should pay attention to details that sometimes get missed — such as how to deal with sanctions that “encumber” providers without suspending their licenses, or what to do when a provider’s incapacity is related to a disability.

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