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CMS Modifies Proposed Changes to E/M Codes

Posted by Emerald Coast Medical Association on Nov 9, 2018 6:00:00 AM

Emerald Coast Medical Association aims to keep our members up to date on the newest legal changes. CMS listened to doctors and decided to delay any changes to codes for Medicare patient visits until 2021. According to the Centers for Medicare & Medicaid Services, doctors were worried that the plan would cut revenue for physicians who care for Medicare patients. Although CMS made changed to its plan, it did decide to continue with its plan to consolidate codes for Medicare patient visits.

Seema Verma, a CMS Administrator, said that they would consolidate codes for “evaluation and management” (E/M) visits to three, maintaining the level 5 code that is used for physicians who see the sickest patients who require more services. The agency will work with doctors to iron out the details, which will delay implementation to 2021. The E/M changes are part of a final rule that outlines the physician fee schedule for 2019. Along with that also come changes to the third year of the physician payment system implemented under MACRA.

The American Medical Association is on board with the revisions of the original proposed E/M policies. They are grateful that the administration is not moving forward with the payment collapse of E/M codes in 2019. The two-year window allows time for an AMA-convened workgroup to look over and make recommendations on this controversial topic.

Effective January 1, 2019, CMS will finalize several burden-reduction proposals that were supported by doctors. The final rule, though, will include revisions that preserve access to care for complex patients, equalize certain payments for primary and specialty care, and allow the delay in implementation of E/M coding reforms until 2021.

The original implementation would have been much sooner, but CMS received over 15,000 comments on a proposed rule that was released in July. Most of the 15,000 comments were in opposition to the change. This change would have collapsed payment rates for eight office visit services for new and established patients down to two each, a massive cut in the overall scheme of things. In addition to that, it also was said it could underpay doctors who treat the sickest patients, which more than 150 medical groups opposed and sent letters disputing the plan to consolidate E/M codes. CMS has released fact sheets with more details about the physician fee schedule, and one outlining changes to the quality payment program under MACRA.

These changes can impact each of our members significantly, which is why we like to make our members aware of them.

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Topics: Medical Law, News

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