The PHE Is Over - Medical Billing Now Has A New Normal

by  Find-A-Code™
Jul 17th, 2023

The Public Health Emergency (PHE) initiated at the start of the COVID pandemic is over. It was allowed to expire in mid-May. With its expiration comes a 'new normal' for medical billing – particularly in the area of telemedicine. It is now up to facilities, clinicians, and medical billing and coding staff to acquaint themselves with CPT codes that will no longer be usable for billing purposes.

Handling the pandemic required the Centers for Medicare and Medicaid Services (CMS) to make some concessions regarding virtual visits. Not only did CMS greenlight virtual doctor visits for all sorts of reasons, but their decision to do so also led to the establishment of some new CPT codes. Some of those codes are now going away with the expiration of the PHE.

A Common Language for Billing

If you are new to the whole medical billing concept, CPT codes were originally designed to create a common language for medical billing purposes. The idea was to create codes for various procedures and services as a shorthand of sorts, thereby creating a set of standards through which insurance companies and public initiatives, like Medicare and Medicaid, could be billed.

CPT codes represent just one code set medical billers and coders have to work with. Other sets include ICD-9, ICD-10, and even the newest kid on the block: ICD-11. It is incumbent upon healthcare providers and their billing departments to utilize the right codes on each and every bill.

As CMS Goes...

At the time of this writing, the PHE's expiration was only a month old. Already though, private insurance carriers have begun adopting the same changes embraced by CMS. That's how it goes. CMS exerts a tremendous amount of influence over the entire U.S. healthcare sector. Private carriers are more likely to follow their lead than do something different.

When CMS says that certain CPT codes are no longer usable, private carriers tend to follow. The big thing right now is telemedicine. CMS is back to insisting that, in most cases, a clinician be present in the room in order to bill for services.

During the pandemic, this particular requirement was waived. Doctors and other clinical staff could perform virtual supervision using live audio and video. But with the end of the PHE, CMS is back to wanting clinical staff to visit with patients in person.

Continuing to use medical billing codes related to virtual supervision will ultimately mean incorrect bills. Healthcare providers should be aware of this change and take steps to mitigate its effects. Continuing to use the now abandoned CPT codes will only slow payment.

Not All Pandemic Codes Going Away

It should be noted that not all the CPT codes implemented during the pandemic are going away. Many of them remain intact and usable. Clinicians, medical coders, and billers should review CPT codes for familiarity's sake. In the meantime, expect the changes now being implemented to become the new normal for medical coding and billing.

Change is part of the system. New codes are added and old ones dropped every year. Sometimes, there are multiple changes in the same year. When you are dealing with tens of thousands of different codes, this sort of thing is expected.

If you are a medical coder or biller, it is important that you keep up with the changes by ensuring all your sources are up to date. Here at Find-a-Code, we make maintaining accurate and up-to-date records a priority. Our database is a complete catalog allowing you to look up codes in mere seconds. Make it part of your new normal.