Medicare Proposes Evaluation and Management Reform: Specialty Payments Could Be Impacted

Posted July 25, 2018

On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released proposed revisions to payment policies under the Physician Fee Schedule for CY 2019, which totals 1,472 pages. The proposed rule change focuses on reducing administrative burden through major reforms to both documentation and reimbursement for evaluation and management services, which accounts for about 40% of charges paid directly to physicians. While certain specialties will receive reimbursement increases, others will experience payment reductions under the proposed changes.  (Table 22, page 367)     

Additional proposed revisions to Evaluation and Management (E/M) include:

  • the “collapse” of Level 2 through Level 5 E/M codes for both new and established patients into a system with minimal documentation requirements and one single payment rate;
  • a series of add-on-codes that can be used to address complex primary care and non-procedural services for Level 2 through Level 5 visits;
  • the option to use medical decision or time when documenting E/M visits instead of the current 1995 or 1997 E/M documentation guidelines; and
  • the ability for physicians to focus documentation on pertinent items that have changed or have not changed since the patient’s last visit instead of re-documenting information.

The American Medical Association is preparing a summary of the proposed rule for federation members and will collaborate with them on comments to CMS, which are due by September 10, 2018. KMA will keep members up to date on this critical issue through a variety of methods including social media.

Click here for additional information from CMS regarding the proposed rule change.