The holiday decorations have been stored, and New Year’s resolutions have already been broken. It is 2021, and the new Evaluation and Management (E&M) guidelines are now in effect.
As a provider, whether in private practice or hospital based, you may not have prepared for the changes. With COVID-19, political drama, and other regulatory changes, E&M updates may not have been on your top priority or even on your radar. If you didn’t prepare prior to January 1, now what?
While the changes were initially focused on the Centers for Medicare and Medicaid Services (CMS) patients, all commercial insurance companies will follow the new guidelines. The good news is that it is not too late to implement the changes in physician documentation requirements, educate physicians and staff, and optimize workflows. Having peer-to-peer training and support will get you up to speed rapidly.
Providers and office managers may be wondering why these changes are important and what impact they may have on their practice. Based on specialty and the use of time versus medical decision making (MDM) to document the patient visit, reimbursement could change positively or negatively depending on preparation and understanding of the new guidelines.
Due to the elimination of and changes to codes, as well as the factors used in determining which codes to use per patient encounter, reimbursement could be decreased. Physicians can expect decreases in reimbursement for procedures, therapy services, pathology and radiology services and non-office-based practices such as the emergency department, hospital, skilled nursing facilities, assisted living, and home visits. Office-based practices can expect an increase in reimbursement.
The longer medical practices wait to receive education and to educate staff, the more denials and reimbursement issues they may experience.
JTS Health Partners (JTS) offers a comprehensive education plan that is physician-led and provides a unique perspective based on direct experience and clinical knowledge including:
- Peer-to-peer training for physicians and office staff
- E&M review
- Financial analysis to determine potential impact on the practice
- Sustainability plan to ensure compliance now and in the future
Now is the time to operationalize the E&M changes. For more information on how JTS can assist your practice with implementing the 2021 E&M changes, contact JTS at 470-443-3507 or firstname.lastname@example.org.