decisionhealth Newsletters, Part B News - 2016 Issue 7 (July)
Prepare to add prolonged service codes to your E/M roster
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Article Overview
This article explains a proposed CMS change in the 2017 Medicare physician fee schedule that would create a payment pathway for prolonged non-face-to-face E/M services. It is relevant for physicians, billers, coders, and practice managers who track Medicare policy, fee schedule updates, and how prolonged services intersect with care management and transitional care reporting. The article also outlines related billing considerations, including timing, same-day reporting issues, and comments CMS invited on overlap with other service categories.
Why This Topic Matters
The topic matters because it affects whether certain time-intensive, behind-the-scenes provider work may be reimbursable under Medicare and how those services may need to be reported. It also helps practices monitor differences between CMS policy and payer-specific CPT-based approaches.
Article Sections
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Proposed activation of prolonged service codes
Introduces the Medicare proposal discussed in the article and frames the reimbursement context for non-face-to-face prolonged services.
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How the proposed payment approach fits with other non-face-to-face services
Places the topic alongside other care coordination and non-face-to-face service categories referenced in the article.
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Watch out for different billing rules
Addresses differences between Medicare’s proposed approach and other payer or CPT-based policies, along with related timing considerations.
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Note 2 additional billing requirements
Summarizes additional proposed policy issues involving time tracking, overlap with other services, and areas where CMS sought public comment.
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Non-face-to-face prolonged service codes, RVUs and estimated payment, 2017
Provides a table summarizing the article’s referenced payment and valuation information for the prolonged service codes.
What You Will Learn
- How CMS proposed to recognize prolonged non-face-to-face E/M services under Medicare
- How the article situates prolonged services among other care management and transitional care topics
- What kinds of billing-policy differences between Medicare and payer/CPT approaches are highlighted
- Which general areas of overlap and timing concerns CMS asked stakeholders to comment on
- How the article presents the proposed valuation and payment context for the discussed services
Who Should Read This
- Medical coders
- Billing staff
- Physician practices
- Practice managers
- Compliance professionals
- Health care consultants
- Primary care organizations
Codes Discussed
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