News & Publications

Big Changes on the Horizon: Documenting Office and Outpatient E&M Visits

Journal of Health Care Compliance January – February 2019

Lesley Yeung, Senior Counsel in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, authored an article in the Journal of Health Care Compliance, titled “Big Changes on the Horizon: Documenting Office and Outpatient E&M Visits.”

Following is an excerpt (see below to download the full version in PDF format):

In October 2017, the Centers for Medicare & Medicaid Services (CMS) launched the “Patients over Paperwork” initiative, meant to reduce unnecessary administra­tive burden, increase efficiencies, and improve the ben­eficiary’s experience when seeking health care services. The goal of CMS’s efforts to identify and eliminate overly burdensome administrative tasks is to minimize distrac­tions and allow practitioners to focus their time and attention on actual patient care.

As part of these efforts to reduce provider burden, CMS made an ambitious proposal this summer to reform evaluation and management (E&M) coding and documentation requirements under the Medicare Part B Physician Fee Schedule (PFS). This proposal, accord­ing to CMS, stems from concerns voiced by health care practitioners that the existing E&M coding guidelines are outdated, complex, ambiguous, and fail to distin­guish meaningful differences among the five levels of E&M office visit codes. CMS’s proposal aims to make use of electronic health records more efficient and effective and to improve documentation workflows to support patient-centered care instead of being focused on meeting billing documentation requirements.

Specifically, CMS proposed to eliminate the existing documentation requirements that differ for each of the five levels of E&M codes for office and outpatient visits. Instead, CMS proposed to adopt a minimum documenta­tion standard, whereby practitioners would have a choice to code based on medical decision making (MDM) or time, or to continue using the current framework based on either the 1995 or 1997 E&M documentation guide­lines. In conjunction with the documentation reform proposal, CMS also proposed to apply single-blended payment rates for new and established patients for office and outpatient E&M visit levels two through five.

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