13 Jul Possible CMS Billing Rules Overhaul

Multiple sources reported yesterday that the Centers for Medicare and Medicaid Services (CMS) proposed overhauling Medicare billing standards that have been in place since the 90’s.  Anyone who is a physician, coder, works with coding staff, or is otherwise affected by, and versed in the requirements that must be met for documenting and billing evaluation and management services, should be interested in these potential changes.

The proposed changes are intended to accommodate billing for telemedicine services.  The current rule for establishing the level of service for E&M services is based on review of systems and level of decision making dependent upon the complexity of the diagnosis, which determines the medical necessity for the level chosen.  CMS’s proposal would change the rule for level of service determination to one based on medical decision making and time spent with the patient.  Additionally, CMS is considering eliminating the current policy that prevents visits on the same day with multiple practitioners in the same specialty within a group practice.

As with any major proposal, there are mixed reviews in the early reactions to the proposed changes.  Although the level of complexity in determining the level of service may diminish, there is concern that these changes will negatively impact physician reimbursement.

We will stay tuned, and keep you informed as further information on this topic is available. You can read more about these proposed changes in Modern Healthcare.

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