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Analysis

Doc Groups Laud CMS' E/M Reforms, Red Tape Reductions

By John Commins  
   November 04, 2019

The final rule updates the longstanding E/M documentation and coding framework used by clinicians to bill Medicare.

The federal government's efforts to reduce physician paperwork and reward coordinated care for chronically ill patients are getting a warm reception from physician associations.

The Centers for Medicare & Medicaid Services says the final rule unveiled on Friday will feature red tape reductions that will save the nation's physicians about 2.3 million hours per year in burden reduction.

The changes update the longstanding evaluation and management documentation and coding framework used by clinicians to bill Medicare for routine office visits. CMS is also increasing payment for office and outpatient E/M visits and offering enhanced payments for chronic care management.

"Historic simplifications to billing requirements mean that clinicians will be able to focus on recording the information that’s most important to keeping a patient healthy," Health and Human Services Secretary Alex Azar said in a media release.

"As we move toward a system that pays more and more providers for outcomes rather than procedures, we look forward to freeing clinicians from even more of these burdens," he said.

Robert McLean, MD, president of the American College of Physicians, said Medicare has for too long undervalued E/M codes by primary care physicians.

"At the same time, physicians were faced with excessive documentation requirements to be paid for such services," McLean said. "ACP is extremely pleased that CMS’s final payment rules will strengthen primary and cognitive care by improving E/M codes and payment levels and reducing administrative burdens, in line with ACP's Patients Before Paperwork initiative."

American Medical Association President Patrice A. Harris, MD, said the nation's largest physician association worked with CMS to complete the first overhaul of E/M office visit documentation and coding in more than 25 years.

"Physicians spend a huge amount time meeting burdensome documentation requirements during patient interactions, which takes time away from patients and contributes significantly to burnout and professional dissatisfaction, Harris said. "This new approach is a significant step in reducing administrative burdens that get in the way of patient care."

The AMA said that key elements of the E/M office visit overhaul include:

  • Eliminating history and physical exam as elements for code selection. While significant to both visit time and medical decision-making, these elements alone should not determine a visit's code level.
     
  • Allowing physicians to choose whether their documentation is based on medical decision-making or total time. This builds on the movement to better recognize the work involved in non-face-to-face services like care coordination.
     
  • Modifying MDM criteria to move away from simply adding up tasks to focus on tasks that affect the management of a patient’s condition.
     

With the final rule in place, Harris said it is "time for vendors and payors to take the necessary next steps to align their systems with E/M office visit code changes by the time the revisions are deployed on January 1, 2021."

"In the coming months, the AMA will undertake an aggressive effort to ensure that EHR providers, coders, payors and other vendors implement simplified coding so physicians no longer labor under undue documentation complexity," Harris said.

While praising the E/M reforms, the AMA said it was also "concerned about significant payment reductions" anticipated for some clinicians, including psychologists and physical therapists.

"The Association will work through the course of the next year to convince CMS that all specialties' payment for office visits should be recognized as equivalent. This was demonstrated by the survey of 50 different specialties—a survey lauded by CMS," AMA said.

McLean says the reforms could also address the growing shortage of primary care physicians.   

"Fewer physicians are going into office-based internal medicine and other primary care disciplines in large part because Medicare and other payers have long undervalued their services and imposed unreasonable documentation requirements," he said. "CMS's new rule can help reverse this trend at a time when an aging population will need more primary care physicians—especially internal medicine specialists to care for them."

“This new approach is a significant step in reducing administrative burdens that get in the way of patient care.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

Final rule eliminates history and physical exam as elements for code selection. 

Physicians will be allowed to choose whether their documentation is based on medical decision-making or total time.

The final rule modifies medical decision-making criteria to move away from adding up tasks to focus on tasks that affect the care management.


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