Revenue Cycle
and Billing

Get Ready for the E/M Coding Changes Coming January 2021

by | Nov 19, 2020 | Affordable Care Act (ACA), coding, main post, Medical Billing, Providers

Changes to physician outpatient CPT coding for evaluation and management (E/M) services take place on January 1, 2021. The billing changes impact more than 50% of E/M services for all providers who see patients in offices or clinics. The changes impact commercial payers, not just Medicare and Medicare Advantage plans. 

The Centers for Medicare & Medicaid Services (CMS) is implementing the changes to decrease the number of time physicians dedicate to documentation paperwork, giving them more time to spend with patients. The American Medical Association (AMA) worked with CMS to develop the changes and believe the extension of the guidelines and definitions will result in fewer audits. 

The Changes

Beginning in 2021, you will need to document visits based on time or medical decision-making. This includes both face-to-face and telehealth visits. 

  • Face-to-face visit documentation includes examination and counseling and education. 
  • Telehealth visits include: 
    • Time spent preparing to see each patient
    • Reviewing test results and obtained patient history
    • Obtained history 
    • Orders
    • Documentation
    • Care coordination

Is Your Practice Ready?

Decreasing the likelihood of an audit may sound great, but if you aren’t using professional coders, you could be putting yourself at risk. The changes also allow you to create resource-based reimbursement. If you aren’t using professional coders, you may not maximize your revenue opportunities. 

Getting up to speed on the coding changes takes time and money. Our Medical Billing Department has undergone hours of online training and testing to prepare for the coming changes. The training for each staff person was several hundred dollars. Even after all that, they still had work to do.

Telehealth Visits    

Because the changes include telehealth services, our public health billing, and coding professionals had to identify how each carrier handles billing for telehealth services. Telehealth became a big issue when the coronavirus first hit. Payers rushed to implement billing policies. There was no uniformity. Things improved as the summer wore on and the payers tried to get on the same page. But now, some are going back to pre-COVID protocols. 

That means having to map out how each carrier handles reimbursement for telehealth visits.  Different carriers have different policies within their Medicare Advantage, Medicaid, and commercials plans, so it was a time-consuming effort for our entire team.

Your Bottom Line

The bottom line is that it will take your coders a lot of time to understand the changes and be able to code physician outpatient services correctly. This could lead to billing backlogs and underbilling, causing you to lose revenue. 

American Exchange can reduce the administrative burden and keep your revenue stream going strong. We provide coding and billing services, and also offer an enterprise revenue cycle management (RCM) solution. Our coding professionals are experts in both public health and private insurance. 

Give us a call to start 2021 off on the right foot and maximize your reimbursement: 888.995.1674.