With the Release of the 2020 Physician Fee Schedule & the Final Rule, CMS Confirms the Direction of Upcoming E/M Changes
Welter Healthcare Partners is providing new information regarding E/M changes in 2020. Read the updates below on what is coming next year for coding, along with changes to PCM and CCM.nnWhat’s New for 2020nnThe CY 2020 PFS conversion factor will increase to $36.0896, up to $0.05 from CY 2019. nnThree new Telehealth Service codes added to the Medicare-covered services list:n
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- G2086 (Office-based treatment for opioid use disorder, including the development of the treatment plan, care coordination, individual therapy, and group therapy and counseling; at least 70 minutes in the first calendar month);
- G2087 (Office-based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; at least 60 minutes in a subsequent calendar month); and
- G2088 (Office-based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes).
- CMS will offer these services without the usual geographical limitations for telehealth.
- The Medicare telehealth originating site fee increased to $26.65 in 2020, from $26.15 in 2019.
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nPrincipal Care Management (PCM) for Chronic Care Management (CCM) nnIf you provide chronic care management (CCM) to patients with one chronic condition next year, report code G2064 for 30 minutes of work by a doctor or other qualified health care professional: “Comprehensive care management services for a single high-risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: One complex chronic condition lasting at least three months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.” When clinical staff performs the work, you will report G2065.nnReduction of Administrative BurdennnModifications to the documentation policy now allows physicians, physician assistants, and advanced practice registered nurses (APRNs – nurse practitioners, clinical nurse specialists, certified nurse-midwives and certified registered nurse anesthetists) to review and verify (sign and date), rather than re-documenting, notes made in the medical record by other physicians, residents, medical, physician assistant, and APRN students, nurses, or other members of the medical team. CMS also defined the APRN group of providers, which includes nurse practitioners, clinical nurse specialists, certified nurse-midwives and certified registered nurse anesthetists.nn
Physician Assistants Make Ground n
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- CMS’ finalized its proposal to adjust the authority of physician assistants (PA): Allowing them to practice without specific assignment to an M.D., requiring only “documentation in the medical record of the PA’s approach to working with physicians”.
- Requires that in states where the PA’s scope of practice is not specified, the PA’s “working relationship” with the practice’s physicians must be documented “at the practice level.”
- CMS cautiously approved its proposal to allow certified registered nurse anesthetists (CRNAs) to do pre-anesthesia assessments on patients as well as post-anesthesia assessments without the supervision of an M.D. CMS clarifies that “a physician must examine the patient to evaluate the risk of the procedure to be performed,” while either “a physician or anesthetist must examine the patient to evaluate the risk of anesthesia.”
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nCMS Final Rule Aligns with E/M coding changes laid out by the CPT Editorial Panel for office/outpatient E/M visits beginning in 2021n
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- Reduce the number of levels to 4 for office/outpatient E/M visits for new patients (99202-99205);
- Retain all 5 levels of coding for established patients (99211-99215);
- Revision of time-based reporting and medical decision-making process for all office-based E/M codes; performance of history and exam only as medically appropriate (complexity will be more clearly defined);
- E/M visit level selected based on either medical decision making or time.
- CMS also finalized the relative value units (RVU) for the group of oft-used E/M services, which will determine 2021 pay rates. The RVU changes, for example, would boost payments for code 99214 – the most-reported E/M code – from $109 to $136 per claim, a 25% increase. Rates for 99213 would jump nearly 30%.
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nThe information provided about was originally published on cms.gov, aafp.org, ama-assn.org, and pbn.decisionhealth.com
CMS’ Innovation Center will delay the start of a new payment model called Primary Care First by a year, according to timeline updates on the model’s information page.nnPrimary Care First, announced in April, was slated to begin in January 2020. Now, it will begin in January 2021. The voluntary model is a set of five-year payment options that tie payment to value and quality metrics in hopes of reducing healthcare costs. Options under the Primary Care First model were set to be offered in 26 regions for a 2020 start date.nnPractices that wish to apply to the model to begin participation in January 2021 could begin applying Oct. 24, 2019. Applications close Jan. 22, 2020.nnRead more about the model 
2019 ICD‐10‐CM updates went into effect on October 1st. These changes will impact encounters for dates of service October 1, 2019 through September 30, 2020. It is imperative that your organization has up‐to‐date coding resources and a keen understanding of the changes that will impact your reimbursement! The new updates can also influence your organization’s MIPS/MACRA quality reporting scores.nnThis year’s ICD‐10‐CM updates include 325 code changes (273 new codes, 15 validity changes, 7 deleted codes, and 30 code revisions).nnHere are notable highlights of the 2020 updates: n
Reactive Hypoglycemia (ICD-10 code E16.1) or a sugar crash can do more than just make you tired. It can lead to feeling of hunger, irritability, anxiousness, headaches or even difficulty concentrating. With Halloween just around the corner, it seems there is a candy dish stocked full of treats everywhere you turn. It’s not just about the effects, it’s also about prevention. Here are a few fun reads on how to keep your blood sugar levels in check during the upcoming holidays.nnSugar Crash Effects and How to fix Them:nnThe sugar high is all fun and games until the resulting sugar crash affects the quality of your day. The term refers to the sudden drop in energy levels after consuming a large amount of carbohydrates. This can include pastas and pizza but is usually more common after eating simple carbohydrates, also known as simple sugars, such as desserts.nnA sugar crash often causes many undesired symptoms that can disrupt productivity and energy levels throughout the day.nnSanford Health, suggests balance, moderation and consistency are the most effective ways to avoid these crashes. Herrick shares her knowledge on sugar crashes, how to avoid them and what to do if you get one.nn
With the development of the health insurance exchange, prices for coverage for those in Colorado are going to drop. This will give families an average of $600-$700, back in their pockets. Read the article below to see when and how this new change will take place.nnFor the first time since Colorado opened its health insurance exchange, the prices people pay for coverage will drop — by a statewide average of 20.2%.nnAnd for families in western Colorado — who face some of the highest health insurance premiums in the nation — the savings could total more than $10,000 per year, according to final numbers for 2020 released by the Colorado Division of Insurance.nn“Just imagine: What could you do with that in your life?” Gov. Jared Polis said. “What could your family do with an extra $600 to $700 a month?”nnThe biggest reason for the price drop — which was higher than projected — is reinsurance, a bipartisan program created by state lawmakers during the 2019 session.nnThe program is basically a pool of $260 million in state and federal money that Colorado plans to use in 2020 to help cover some of the most expensive medical bills from the 250,000 people who buy plans through the state’s individual market. In exchange for the help, insurance companies lowered their monthly premiums.nn“It’s the same plans,” Polis said. “It’s just lower prices.”nnThat means problems such as people not using their insurance because of a high deductible will still exist, but the governor is hopeful that the lower monthly costs will lower the state’s uninsured rate.nn“We think this prices it into the market for many more families,” Polis said, though he didn’t commit to a specific number.nnDetails on the plan options can be found at connectforhealthco.com, with 2020 enrollment beginning Nov. 1.nnThe state lawmakers behind the reinsurance bill told The Denver Post they’re not done working on health care costs, either.nn“We have to attack the basic underlying costs,” said Sen. Bob Rankin, R-Carbondale. “This bill does not address why health care costs so much.”nnHis counterpart in the Colorado House, Rep. Julie McCluskie, D-Dillon, is optimistic about programs such as a public option and something called an alliance model that’s just starting in Summit County.nnPeak Health Alliance is a group of big employers that banded together to negotiate lower prices from their local providers and used those prices to get better rates from health insurance companies. When combined with the reinsurance reduction, McCluskie said, alliance members will see their premiums cut up to 50% next year.nnThe governor hopes that by 2021, many more of these alliances will exist, including a statewide group with state, county and city public employees.nn“There’s absolutely significant upside to an alliance model everywhere in our state, both the regional models and statewide,” Polis said. “We’re aggressively pursuing those opportunities to save people money.”nnOriginal 