Mid-Atlantic Health Law TOPICS

Here are some of the key takeaways from Medicare’s 2019 Physician Fee Schedule Final Rule (Final Rule).

A. Office Visit Coding

Many physicians bill Medicare for outpatient office visits using evaluation and management (E/M) visit codes. Currently, this generic set of codes has five levels of complexity. Beginning in 2021, billing for outpatient office visits will be simplified. 

The Centers for Medicare and Medicaid Services (CMS) plans to collapse code levels 2 through 4 into one code paid at a single rate. CMS will maintain the level 1 and level 5 codes. 

Additionally, CMS plans to allow for flexibility in how levels 2 through 5 visits are documented. Physicians can chose to use the current framework, medical decision-making or time.

B. Relaxed Documentation

The Final Rule eliminates certain electronic health record (EHR) documentation requirements. Now, for established patient visits, providers need only document what has changed since the last visit. Additionally, chief complaints or other historical information already entered into the record by ancillary staff or by patients themselves must only be reviewed and verified by providers. Such information does not need to be re-entered. 

Further, because E/M visit code levels 2 through 4 will be collapsed into a single code, the required documentation related to payment will be limited to what is required for a level 2 visit.

C. Telehealth

Historically, brief virtual check-in services, furnished via communication technology and used to evaluate whether an office visit or other service is warranted, were bundled into the resulting visit, meaning reimbursement was through the subsequent E/M visit code.  Accordingly, there was no reimbursement for virtual check-in services that did not lead to office visits. 

These virtual check-in services will now be reimbursed as standalone services. 

A virtual check-in can be conducted using audio-only, real-time telephone interaction, as well as synchronous, two-way audio interaction that is enhanced with video or other kinds of data transmission. 

It is important to note, however, that the new Healthcare Common Procedure Coding System virtual check-in code covers direct interaction between the patient and the billing provider, meaning telephone calls that involve clinical staff only cannot be billed. 

Also, providers must obtain verbal patient consent to be billed for the virtual check-in and such consent must be documented in the medical record.

Providers will also be reimbursed for the remote evaluation of pre-recorded, patient-submitted images and/or video results when there is no resulting E/M office visit and there is no related E/M office visit within the previous seven days of the remote service being furnished. For example, a new patient seeking care for a specific skin condition could share a pre-recorded image or video with a dermatologist to determine whether an in-person visit is necessary. 

Importantly, the very restrictive geographic and facility patient location requirements that otherwise must be met for Medicare to pay for telehealth do not apply to any of the foregoing.

Barry Rosen
(410) 576-4224 • brosen@gfrlaw.com