Provider groups generally support final rule on E&M documentation

The Centers for Medicare and Medicaid Services on Thursday issued a final rule to streamline Evaluation and Management documentation requirements, but those new regulations have received mixed reviews from physician groups.

As part of the Trump administration’s Patients Over Paperwork initiative, the agency is updating the E&M documentation framework for the first time in more than 20 years, says CMS Administrator Seema Verma.

Verma-Seema-CROP.jpg
Seema Verma, Centers for Medicare and Medicaid Services administrator nominee for U.S. President Donald Trump, speaks during a Senate Finance Committee confirmation hearing in Washington, D.C., U.S., on Thursday, Feb. 16, 2017. Verma, the businesswoman Trump selected to oversee Medicaid, the health care program for 74 million low-income Americans, has said the program is structurally flawed by policies that burden states and foster dependency among the poor. Photographer: Pete Marovich/Bloomberg

“We’re simplifying the documentation so doctors can spend more time with their patients,” said Verma during a press conference. “Our proposal was never expected to be perfect on day one, but we’re very pleased to see it spark debate—and we received a large number of constructive comments that led to the significant refinements in the policy we’re finalizing.”

Verma noted that CMS finalized several burden-reduction proposals that go into effect on January 1 that were overwhelmingly supported by the provider community. However, after listening to the concerns of providers regarding other proposals, she said the final rule includes revisions that preserve access to care for complex patients, equalize certain payments for primary and specialty care and enable continued stakeholder engagement by delaying implementation of E&M coding reforms until 2021.

“AMGA members were very concerned that CMS was moving too aggressively in its plan to streamline the payment and coding for E&M office visits, particularly those providers who treat a large number of complex patients,” says Jerry Penso, MD, president and CEO of the American Medical Group Association, which represents multispecialty medical groups and integrated systems of care. “Maintaining the code for the most complex patient visits somewhat alleviates that concern.”

However, the CMS rule—included in the Calendar Year 2019 Medicare Physician Fee Schedule—has received the full backing of the American Medical Association, which applauded the revisions to the Medicare E&M policies.

“With physicians facing excessive documentation requirements in their practices, it is a relief to see that the administration not only understands the problem of regulatory burden but is taking concrete steps to address it,” says AMA President Barbara McAneny, MD. “Patients are likely to see the effect as their physicians will have more time to spend with them and be able to more quickly locate relevant information in medical records.”

In particular, an AMA statement voiced support for the following E&M revisions:

  • Changing the required documentation of the patient’s history to focus only on the interval history since the previous visit.
  • Eliminating the requirement for physicians to re-document information that has already been documented in the patient’s record by practice staff or by the patient.
  • Removing the need to justify providing a home visit instead of an office visit.
  • Declining to move forward on a proposal to reduce payment for office visits when performed on the same day as another service.
    “Implementation of these policies will streamline documentation requirements, reducing paperwork burdens that interfere with a meaningful patient-physician relationship,” adds McAneny.

Also See: CMS proposed rule reduces Evaluation and Management coding burden

At the same time, McAneny says that the AMA appreciates the fact that CMS is not moving forward in 2019 with the E&M “payment collapse” for office visit services.

“A two-year window for implementation of the proposal will give the AMA-convened work group— comprised of physicians and other health professionals—time to make recommendations on this complicated topic,” McAneny says. “The panel members have deep expertise in defining and valuing codes, and as members of various specialties, they all use the office visit codes to describe and bill for services provided to Medicare patients. The group is analyzing these issues and plans to offer solutions to be provided to CMS for future implementation.”

Likewise, executives of the Medical Group Management Association say they appreciate CMS efforts to reduce documentation burden for E&M office visits starting in 2019, and they welcome the agency’s deferral and revision of the collapsed E&M codes to 2021.

However, Anders Gilberg, MGMA’s senior vice president for government affairs warns that there's more work to be done in resolving the issue.

“Blending payments rates in 2021 won’t necessarily reduce burden, especially with CMS’s newly required add-on codes,” Gilberg says. “MGMA will continue to examine the rule, leverage feedback from members and work with CMS to create meaningful burden reduction for physician practices across the country.”

Nonetheless, as part of the final rule released on Thursday, Medicare will pay providers for new communication technology-based services, according to Verma.

“For the first time, in 2019, Medicare will pay doctors for virtual check-ins with their patients, virtual consultations between physicians, evaluation of remote pre-recorded images and video and an expanded list of telehealth services,” she said.

Verma also indicated that the final rule released on Thursday overhauls the interoperability performance category for the Merit-based Incentive Payment System (MIPS) program.

“This means that physician incentives are now directly tied to doctors updating their systems so that they are interoperable,” added Verma. “And, in this rule, we are also finalizing an opt-in policy so that smaller providers can still participate in the MIPS program if they choose to do so.”

A fact sheet on the Calendar Year 2019 Medicare Physician Fee Schedule can be found here.

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