CMS has changes to evaluation management coding for 2020 and 2021. The 2020 changes are significant and include new services and expansion of existing services. The changes finalized for 2021 include major changes to the physician requirements for documentation related to evaluation management coding.
The changes for 2020 represent significant revenue opportunities for the majority of clinicians that see Medicare patients. CMS would like to expand the CCM and TCM programs as they have been proven to improve the quality of care and reduce overall cost. For some practices these programs may represent between two and 20% of their revenue.
The changes for 2021 will be more impactful as they will remove onerous documentation requirements and allow clinicians to focus on documenting what is needed for patient care. It will also improve the efficiency of documentation, require significant changes to electronic health records, and potentially create audit vulnerabilities if the guidelines are not adhered to closely.
CMS made significant changes to certain Medicare programs, including the Chronic Care Management (CCM) and Transitional Care Management (TCM) programs. CMS also approved a new program for specialists referred to as Principal Care Management. In addition, there were significant changes to Remote Patient Monitoring (RPM) requirements. These programs create new opportunities for primary care physicians and specialists. These will be reviewed in detail during the presentation.
CMS approved landmark changes to the evaluation and management coding requirements for outpatient encounters for 2021. Documentation in the history and physical components of the encounter note will no longer be required to determine the level of service. The level of service will be determined based solely on the level of complexity of the encounter or the total time spent managing the patient during a calendar day. This presentation will review in detail the new requirements. Practices will need to start preparing and training their staff to take full advantage of these changes.Areas Covered in the Webinar:
CEO, Apollo HIT, LLC
Michael Marron-Stearns, MD, CPC, CFPC is a physician informaticist, certified professional coder (CPC), and CEO of Apollo HIT, LLC. Dr. Marron-Stearns has 15 years of direct patient care experience. He served as an assistant professor and neurology residency program coordinator. For the past 21 years he has worked as a informaticist, health information technology and compliance professional. He spent 12 of these years providing leadership and direction to electronic health record vendors.
Dr. Stearns is an accomplished speaker and author on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that includes the MIPS and Advanced Alternative Payment Models. His company, Apollo HIT, LLC provides a range of consulting services to healthcare providers and health information technology organizations. One of his main areas of focus is compliance in the MIPS component of the Quality Payment Program. He was invited to speak on MIPS audit vulnerabilities at the Health Care Compliance Association’s Enforcement Conference in November 2019. Dr. Stearns is also written a series of articles on MACRA for the Journal of the American Health Information Association.
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