On July 17, 2018 Centers for Medicare and Medicaid Services - CMS posted a letter to Doctors. The letter invites doctors to share their ideas with CMS on how to reduce paperwork and focus more time and attention on patients. CMS Administrator Seema Verma tells about current situation and high level of burnout among specialists – when a medical provider spends more time in front of a computer instead of patients’ care this is not okay definitely.

Full text is here.

Moving forward CMS is proposing a number of coding and payment changes to reduce administrative burden and improve payment accuracy for E/M visits:

  • to allow practitioners to choose to document office/outpatient E/M visits using medical decision-making or time instead of applying the current 1995 or 1997 E/M documentation guidelines, or alternatively practitioners could continue using the current framework;
  • to expand current options by allowing practitioners to use time as the governing factor in selecting visit level and documenting the E/M visit, regardless of whether counseling or care coordination dominate the visit;
  • to expand current options regarding the documentation of history and exam, to allow practitioners to focus their documentation on what has changed since the last visit or on pertinent items that have not changed, rather than re-documenting information, provided they review and update the previous information; and
  • to allow practitioners to simply review and verify certain information in the medical record that is entered by ancillary staff or the beneficiary, rather than re-entering it. 

Providers are also invited to give comments on how documentation guidelines for medical decision-making might be changed in subsequent years.

“To improve payment accuracy and simplify documentation, we propose new, single blended payment rates for new and established patients for office/outpatient E/M level 2 through 5 visits and a series of add-on codes to reflect resources involved in furnishing primary care and non-procedural specialty generally recognized services.  As a corollary to this proposal, we propose to apply a minimum documentation standard where Medicare would require information to support a level 2 CPT visit code for history, exam and/or medical decision-making in cases where practitioners choose to use the current framework, or, as proposed, medical decision-making to document E/M level 2 through 5 visits.” 


And also…

“To recognize efficiencies that are realized when E/M visits are furnished in conjunction with other procedures, we propose a multiple procedure payment adjustment that would apply in those circumstances.  We also propose new coding to recognize podiatry E/M visits that would more specifically identify and value these services.  We propose a new prolonged face-to-face E/M code, as well as a technical modification to the practice expense methodology.

We propose to eliminate the requirement to justify the medical necessity of a home visit in lieu of an office visit, and solicit public comment on potentially eliminating a policy that prevents payment for same-day E/M visits by multiple practitioners in the same specialty within a group practice. For E/M visits furnished by teaching physicians, we also propose to eliminate potentially duplicative requirements for notations in medical records that may have previously been included in the medical records by residents or other members of the medical team. 

CMS believes these proposals would allow practitioners greater flexibility to exercise clinical judgment in documentation, so they can focus on what is clinically relevant and medically necessary for the beneficiary. “

Full text is here.

View submitted comments.

Give your comments here by September 10, 2018.