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Preparing for the 2021 E/M Changes

The Medicare Evaluation and Management (E/M) codes will be changing for physician office visits in 2021.  These changes will affect coding protocols and reimbursement.  CBIZ will be providing guidance throughout the year in terms of the scope and breadth of changes, including significant modifications to the work relative value units (wRVUs), the introduction of time-based criteria as a method for reimbursement, the elimination of Level-1 visits for new patients (code 99201), and the modification and further addition of add-on codes for increased reimbursement.  To begin your organization’s preparation, CBIZ suggests implementing the following steps in calendar year 2020:

  • Perform an Impact Analysis
  • Review Existing E/M Coding, Focusing on Medical Decision Making (MDM) Documentation
  • Provide Education

1. Perform an Impact Analysis

Model the financial impact of your office visit distribution with the new changes.  The model should include multiple scenarios for different E/M level distributions.  It also should encompass the revised RVU weights and the add-on codes for prolonged services and primary care.  We also would suggest that your model should include the financial impacts across your organization, by specialty, practice group and individual physician.

2. Review E/M Charts, Focusing on Medical Decision Making (MDM) Documentation

The new E/M regulations will contain different standards for how to document medical decision making.  There are several changes for the new MDM requirements, one of which is the ending of the requirement for a patient’s history as part of the documentation for reimbursement.  A baseline chart review should be performed by experts that will evaluate existing MDM documentation and identify potential gaps that exist between the current documentation and what will be needed for the new 2021 reimbursement guidelines.

3. Provide Education

Education of physicians, hospital management and other related clinicians on the new E&M regulations will be pivotal for your organization to ensure an effective transition to the new documentation rules.  Your education program should focus on the key drivers of reimbursement under the new regulations, including medical decision making and time-based reimbursement.

For any questions or for information on how CBIZ can assist during this transition period, please contact our office at 800-957-6900 or email at [email protected].

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