Outsource Receivables Inc. strives to stay updated on changes in the healthcare industry while also helping our clients and other healthcare professions stay informed as well. As we enter 2021, there are important changes occurring in E/M codes (evaluation and management services) and Medicare that providers and billers should know.
According to released proposals by the Centers for Medicare & Medicaid Services (CMS), Medicare will be facing around an 11% cut to the Medicare physician fee schedule’s CF; in other words, the rate will reportedly drop from $36.09 to $32.26 in 2021. Additionally, the guidelines for E/M codes will be experiencing an overhaul in the new year. The change hopes to improve overall support patient care by reducing administrative burdens, improving payment accuracy, and improving the office/outpatient office codes set. Previously, physicians claimed that the codes were used as a complex scoring system that did not reflect the true work done during the office visits. Healthcare officials were already implementing changes this year as a response.
In general, the changes that went into effect on January 1, 2020 aimed to solve those issues by requiring the office to only record what has changed since the last visit—instead of re-recording patient history—hopefully reducing documentation time. The changes that will go into effect on January 1, 2021 include:
  • Deletion of code 99201 and revision of codes 99202-99215.
  • Extensive changes to a variety of E/M guidelines
  • Requiring code level selections based on medical decision-making (MDM) or total appointment time
A major change to the guidelines outlines how clinicians consider time when recording outpatient visits. Previously, it was defined as how long they spent face-to-face with the patient; after the update, it will also include non face-to-face work on the day of the appointment. Activities like reviewing tests in before the patient’s visit, counseling the patient or caregiver, reporting tests results, ordering tests or procedures, and documentation work completed remotely.
The updates will also affect financial aspects of the E/M codes; the relative value units (RVU) will be increased for the 99211-99215 office codes. Essentially, since physician services are based on RVUs assigned to a CPT code multiplied by the conversion factor, a decrease in the conversion factor will result in significant pay changes. Some specialties will see an increase while its projected that many will see a decrease. For example, experts are already projecting a 13% increase for family practice while chiropractic practice could lose 10%.
Ensure your billers are all updated on these changes and the specifications given by the CMS. Our billing staff are experts in the industry and use state-of-the-art technology to improve the revenue cycles of our clients. If you’re interested in improving your clinic’s bottom line in 2021, give Outsource Receivables Inc. a call.
Speak With An Expert