Care Coordination Playing Key Role in E/M Coding Change Success

On the surface, it may have looked like the Centers for Medicare and Medicaid Services were delivering mixed messages to medical practices and other outpatient providers when it simultaneously changed coding and documentation requirements for evaluation and management (E/M) services while decreasing the reimbursement rate for most care coordination modalities—changes that went into effect on Jan. 1. Does this signal less support from CMS for care coordination? And should this slow providers’ progress in adopting care coordination in their practices? No to both, says Faith Jones, director of care coordination and lean consulting for HealthTechS3.

“I’ve been around Medicare enough to know that they often have to rob Peter to pay Paul,” she explains. “These changes, coupled together, are budget neutral. And despite the slightly lower reimbursement for care coordination, it’s overall great news both for primary care providers and the patients they serve.”

Changes effective Jan. 1, 2021

New this year, physicians can decide whether to code E/M visits by medical decision-making or by total time, including nonpatient-facing activities, such as looking at past medical records, talking to other physicians and even talking to the patient’s family. The change also allows for shared visits, in which a physician and another qualified healthcare professional, such as a nurse practitioner or certified nurse specialist, to jointly provide services related to the visit.

While this represents a major change for providers, it’s also a welcome one, as tedious, onerous documentation requirements have forced providers to spend too much time at each visit taking histories and collecting information and not enough time addressing the patient’s needs and concerns. 

But taking advantage of this new streamlined approach will require both operational and workflow changes. “It’s a huge change,” explained Julie Seaman, director of coding and CDI for eCatalyst, in a November post on this blog. “This is going to require changes to the EMR, and it’s going to change how practices utilize their staff, now that histories don’t have to be documented by the physician and shared visits are now allowed.”

The impact on care coordination

While the E/M coding changes don’t explicitly mention care coordination, Jones says care coordinators will play a major role in helping improve visit efficiency and making sure patient encounters are as productive as possible.

“Care coordination is key to making sure these patient visits are efficient,” Jones says. “It’ll be the care coordinators who are making sure all the pieces are in place for an E/M visit, such as lab and test results and all the other health information needed for the provider to have a productive visit. When the care coordination is done ahead of time, the provider has all this pertinent information at their fingertips and so they can then take the time with the patient to address their specific needs.”

Learning curve expected

Seaman and Jones will be hosting the webinar How are the Changes in the Physician Fee Schedule Affecting Your Care Coordination and Visit Billing? on Jan. 21 to provide an overview of the changes to both E/M coding and care coordination. They’ll also be providing ample time for questions. 

“Now that the time has come to implement, there might be things you thought you knew, but as you got started, you’re suddenly questioning,” Jones says. “Bring your questions and we’ll try to clarify anything that’s not making sense to you.”

Don’t miss this informative webinar—reserve your spot today