Medicare Proposes Evaluation and Management Reform: Update

Posted August 1, 2018

KMA continues to work through the Medicare proposed rule change that focuses on reducing administrative burden through major reforms to both documentation and reimbursement for evaluation and management services.

Updates and 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;
  • Medicare indicated that the “add-on” service used for more complex patients could be as much as $67.00 per appointment
  • Initiation of a “Multiple Procedure Payment Reduction” to be applied when E/M services are furnished in conjunction with other services. If applied the MPPR would reduce payment by 50% for the least expensive procedure or visit that the same physician (or a physician in the same group practice) furnishes on the same day as a separately identifiable E/M visit, currently identified on the claim by an appended modifier -25
  • 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. KMA will keep members up to date on this critical issue through a variety of channels including social media.

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