E/M codes changed January 1 - Has your practice changed processes

By ION

Evaluation and Management (E/M) code changes went into effect on January 1, the first major change in decades. While the changes are intended to reduce administrative burden on providers, getting teams to understand the changes will take some office procedural shifts.

Choosing how you bill can be determined by either the total time you treat a patient or by medical decision-making. The Centers for Medicare & Medicaid Services (CMS) has created a fact sheet which provides more specifics on Payment for Office/Outpatient Evaluation and Management (E/M) and Analogous Visits at: https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1.

It was expected that many specialty practices may see a slight boost in reimbursements with the increased relative value unit (RVU) of many of the E/M codes.

For practices using InfoDive, reports can be generated to monitor E/M levels for all providers, helping to identify patterns within the practice. The reports can be used to benchmark providers to national specialty-specific benchmarks, helping to reduce the risk of an audit, or compare providers within the practice to understand where adjustments and further education may be needed.

Our Business Optimization team can help you understand and implement the E/M coding changes in your practice. To learn more, email practiceconsulting@amerisourcebergen.com.