Вы находитесь на странице: 1из 14

Learn the Ins and Outs of the 2019 MPFS Final

Rule
Speaker: Nikki Taylor, MBA, CPC®, COC™, CPMA®, CRC™

1
Learning Objectives

• Learn how CMS is helping reduce administrative burden


• Understand requirements for MDM for homevisits
• Gain helpful insight into E/M documentation changes
• Get the inside scoop on how reimbursement may change for the
future
• Nail down the changes to virtual care including virtualcheck-ins
• Highlight helpful tools and resources tohelp you keep track of all of
the changes

2
2019 Medicare Physician Fee Schedule Timeline

Proposed Public Final Rule Final Rule


Rule Comment Published Effective
• July 12, 2018 Period • November 1, • January 1,
• Ended 2018 2019
September
10, 2018

3
Patients Over Paperwork Initiative

• Physician burnout is an issue


• Most healthcare organizations
• Impacts:
• Physicians
• Practice/organization
• Patients

• Clinicians may switch to administrative roles orleave


healthcare
• Removes them from their “first love” treating patients
• Contributing factors for physicianburnout…
• Documentation requirements
• EHRtechnology

4
Patients Over Paperwork Initiative, cont.

• Focuses on reducing administrative burden


• Improving care coordination
• Health outcomes
• Patients’ ability to makedecisions
• Regulatory requirements and unnecessary paperwork steal time from patient
care

5
Patients Over Paperwork Initiative, cont.

• Changes to the Physician Fee Schedule addresses those problems


• Streamlines documentation requirements
• Brings focus back to patient care
• Proposing to modernize payment policies
• Medicare beneficiaries can take advantage of the latesttechnologies

6
Shore Up Home Visit Documentation Requirements

• Some documentation
requirements for home visits
eliminated
• Would have to justify medical
necessity
• Office visits are less expensive to
the program
• Clinician can decide between an
office or home visit

7
Payment Rates for Home vs. Office Visits

• Payment rates higher than office based visits


Home visit code 2019 Fee Schedule Office visit code 2019 Fee Schedule
99341 $56.22 99201 $46.49
99342 $81.09 99202 $77.48
99343 $132.26 99203 $109.92
99344 $185.24 99204 $166.86
99345 $225.24 99205 $209.75
99347 $56.22 99212 $45.77
99348 $85.41 99213 $75.32
99349 $131.18 99214 $110.28
99350 $182.00 99215 $147.76

8
Medical Record Documentation and Patient Care

• Documentation is critical for quality patient care


• Medical record documentation reports:
• Patient care received
• Record of
• Pertinent facts
• Findings
• Observations about health history
• Helps evaluate and plan treatment and monitor patients
• Complaints—notes written to comply with coding requirementsDO NOT
support patient care

9
Levels of E/M Visits

How it works…
• Physicians and other practitioners bill for office/outpatient E/M visits
using a set of CPTcodes
• Distinguish visits based on:
• Level of complexity
• Site of service
• New or established
https://www.supercoder.com/medical-
coding-webinars/ins-and-outs-of-the-2019-
medicare-physician-fee-schedule-final-rule

10
46
Big Takeaways

• Patients Over Paperwork Initiative


• 2019 E/M documentation requirements have
changed
• Virtual care expanded with new and revised
codes
• ESRD and Stroke care see changes
• 2021 E/M coding, payment, and documentation
structure will change
• Changes to the Quality Improvement Program

12
Resources

• https://www.cms.gov/About-CMS/Story-Page/CY-19-PFS-Final-Rule-
PPT.pdf
• www.supercoder.com
• https://cdn2.hubspot.net/hubfs/558940/Immunization%20Against%2
0Burnout.pdf?t=1525207992781

13
https://www.supercoder.com/medical-
coding-webinars/ins-and-outs-of-the-2019-
medicare-physician-fee-schedule-final-rule

14

Оценить