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The Billers’ Association for Long-Term Care (BALTC) is a membership community created specifically for professionals involved in the long-term care revenue cycle. This national association provides members with a resource of continuously updated tools, reimbursement and regulatory guidance, and education to help prevent revenue loss and documentation and billing errors so providers can withstand audits at any point in time. With its involved expert advisory board members and active talk group, this engaged group of professionals is a great place for sharing and receiving best practices, tips, and tools with your peers.

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CMS final rule makes changes to how physicians are paid, delays E/M coding reform

Nov 02, 2018
The Bottom Line

As part of a final rule published by CMS yesterday to reduce provider burnout, the implementation of coding reforms for physician services known as “Evaluation and Management” (E/M) visits--requirements that haven’t been updated in 20 years--were delayed until 2020 to allow for continued stakeholder engagement. For CY 2019 and CY 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits and practitioners should continue to use either the 1995 or 1997 E/M documentation guidelines to document E/M office/outpatient visits billed to Medicare, according to a CMS fact sheet. Additional policies for CY2019 and beyond are listed in the fact sheet.

After consideration of concerns raised by commenters in response to the proposed rule, writes CMS, they are not finalizing aspects of the proposal that would have: (1) reduced payment when E/M office/outpatient visits are furnished on the same day as procedures, (2) established separate coding and payment for podiatric E/M visits, or (3) standardized the allocation of practice expense RVUs for the codes that describe these services. Click here to view 2018 E/M payment amounts.

The rule outlines additional changes, including the following:

  • Updates to some policies under Medicare’s Accountable Care Organization program

  • Provides access to “virtual” care, including Medicare reimbursement for brief check-ins between patients and practitioners and evaluation of remote pre-recorded images and/or video

  • A reduction to payment amounts for Part B drugs, effective January 1, 2019

  • A finalized overhaul of EHR requirements to promote interoperability

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