Learn the Ins and Outs of the 2019 Medicare Physician Fee Schedule Final Rule

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Learn the Ins and Outs of the 2019 MPFS Final
Rule Speaker Nikki Taylor, MBA, CPC, COC,
CPMA, CRC
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Learning Objectives

• Learn how CMS is helping reduce administrative
  burden
• Understand requirements for MDM for home visits
• Gain helpful insight into E/M documentation
  changes
• Get the inside scoop on how reimbursement may
  change for the future
• Nail down the changes to virtual care including
  virtual check-ins
• Highlight helpful tools and resources to help you
  keep track of all of the changes

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2019 Medicare Physician Fee Schedule Timeline

• Proposed Rule
• July 12, 2018

• Public Comment Period
• Ended September 10, 2018

• Final Rule Published
• November 1, 2018

• Final Rule Effective
• January 1, 2019

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Patients Over Paperwork Initiative

• Physician burnout is an issue
• Most healthcare organizations
• Impacts
• Physicians
• Practice/organization
• Patients
• Clinicians may switch to administrative roles or
  leave healthcare
• Removes them from their first love treating
  patients
• Contributing factors for physician burnout
• Documentation requirements
• EHR technology

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Patients Over Paperwork Initiative, cont.

• Focuses on reducing administrative burden
• Improving care coordination
• Health outcomes
• Patients ability to make decisions
• Regulatory requirements and unnecessary paperwork
  steal time from patient care

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Patients Over Paperwork Initiative, cont.

• Changes to the Physician Fee Schedule addresses
  those problems
• Streamlines documentation requirements
• Brings focus back to patient care
• Proposing to modernize payment policies
• Medicare beneficiaries can take advantage of the
  latest technologies

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Shore Up Home Visit Documentation Requirements

• Some documentation requirements for home visits
  eliminated
• Would have to justify medical
• necessity
• Office visits are less expensive to the program
• Clinician can decide between an
• office or home visit

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Payment Rates for Home vs. Office Visits

• Payment rates higher than office based visits

Home visit code 2019 Fee Schedule Office visit code 2019 Fee Schedule
99341 56.22 99201 46.49
99342 81.09 99202 77.48
99343 132.26 99203 109.92
99344 185.24 99204 166.86
99345 225.24 99205 209.75
99347 56.22 99212 45.77
99348 85.41 99213 75.32
99349 131.18 99214 110.28
99350 182.00 99215 147.76
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Medical Record Documentation and Patient Care

• Documentation is critical for quality patient
  care
• Medical record documentation reports
• Patient care received
• Record of
• Pertinent facts
• Findings
• Observations about health history
• Helps evaluate and plan treatment and monitor
  patients
• Complaintsnotes written to comply with coding
  requirements DO NOT support patient care

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Levels of E/M Visits

• How it works
• Physicians and other practitioners bill for
  office/outpatient E/M visits using a set of CPT
  codes
• Distinguish visits based on
• Level of complexity
• Site of service
• New or established

Click Below to Read Download Full
PPT https//www.supercoder.com/medical-coding-web
inars/ins-and-outs-of-the-2019-medicare-physician-
fee-schedule-final-rule
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Big Takeaways

• Patients Over Paperwork Initiative
• 2019 E/M documentation requirements have changed
• Virtual care expanded with new and revised codes
• ESRD and Stroke care see changes
• 2021 E/M coding, payment, and documentation
  structure will change
• Changes to the Quality Improvement Program

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Resources

• https//www.cms.gov/About-CMS/Story-Page/CY-19-PFS
  -Final-Rule- PPT.pdf
• www.supercoder.com
• https//cdn2.hubspot.net/hubfs/558940/Immunization
  20Against2 0Burnout.pdf?t1525207992781

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Click Below to Read Download Full
PPT https//www.supercoder.com/medical-coding-web
inars/ins-and-outs-of-the-2019-medicare-physician-
fee-schedule-final-rule