The Centers for Medicare & Medicaid Services (CMS) has finalized its new physician payment schedule and regulatory changes that go into effect on Jan. 1, 2021. There’s good news in the updates, according to the American Academy of Neurology.

CMS expects payments across the specialty of neurology to increase by 6 percent “with variations depending on the individual provider’s practice,” AAN wrote in a recent statement.

Dr. Korwyn Williams, vice-chair of the AAN’s coding and payment policy subcommittee, spoke at the organization’s fall meeting, focusing on changes being made to outpatient evaluation and management (E/M) codes.

“For a large majority of neurologists, E/M accounts for well over half of their revenue,” he said, while 20 percent derive all revenue from E/M. “If used effectively, the new rules can save you time from having to document unnecessary bullet points in the record, and instead allow you to focus on your patient.”

Under the new CMS payment schedule, when determining the level of coding, neurologists will have the choice between medical decision making or total time spent on the day of the patient encounter.

“All of the auditing that you’ve seen previously for your outpatient visits — as far as how many elements of the history, how many reviews of systems did you include, how many organ systems you include — won’t matter anymore,” Williams said.

The medical decision-making table has also changed. But, according to Williams, these changes more closely align the decision making and choosing a code level with medical necessity.

“Put another way, the correct level of service is really determined by how sick a patient is,” he said.

Alternatively, the parameters used to determine time spent with the patient have become significantly more expansive. Williams said this now includes the following:

  • Preparing to see the patient, obtaining or viewing separately obtained history.
  • Time in the room doing a history and exam, counseling and educating the patient’s family or caregiver.
  • Ordering medications, tests, or procedures, referring or communicating with other healthcare professionals after the face-to-face visit.
  • Working from home late at night, documenting clinical information in the health record, independently interpreting results, or providing care coordination.

All of this time spent counts toward determining your final E/M coding, as long as it is provided on the same day the patient is seen.

For each patient, “you have to consider both time and medical decision making,” said Williams. “Whichever one is more reflective of the effort and more appropriately represents what you’ve done is the one that you’ll be able to choose.”

Williams sees these changes as positive and urges his fellow neurologists to understand how they can best use them. To that end, he referenced several tools provided by the AAN.

Likewise, according to AAN’s recent statement, the organization “is highly supportive of the new coding and payment structure and lauds the agency for moving forward with implementation.”

AAN does point out, however, that the increases in payment for E/M are being balanced out by cuts to other services. Neurologists who bill for few E/M services may see overall payment reductions. For this reason, the AAN is still actively working on E/M reform and they urge their members to join in the effort.

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