decisionhealth Newsletters, Coder Pink Sheets - 2018 Issue 8 (August)
Proposed 2019 fee schedule: CMS proposes sweeping changes to E/M payments, documentation requirements
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Article Overview
This article explains major CMS proposals in the 2019 Medicare physician fee schedule that would affect evaluation and management reimbursement, documentation expectations, and related service reporting. It is relevant to physicians, coders, billers, and practice administrators who follow Medicare payment policy, specialty-specific E/M changes, therapy reporting updates, and other proposed fee schedule revisions.
Why This Topic Matters
The proposal could change how common office visit services are paid and documented, with implications for workflow, specialty revenue, and compliance preparation. It also includes related updates that may affect therapy assistant reporting, non-face-to-face services, and interprofessional communication billing.
Article Sections
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Proposed E/M payment changes
Summarizes the proposed Medicare payment structure changes for office-based evaluation and management services and the general timing of the proposals.
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Documentation requirements get flexible
Describes proposed changes to E/M documentation expectations and options under the 1995 and 1997 guideline framework.
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Other proposed E/M changes
Covers additional E/M-related proposals, including same-day visit and procedure payment adjustments, specialty add-on coding, and primary care-related add-ons.
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Other notable proposals
Reviews other fee schedule topics including conversion factors, code revaluation nominations, therapy reporting updates, technology-based services, and interprofessional consultation changes.
What You Will Learn
- How CMS proposed to change Medicare payment for common office E/M services
- What types of documentation flexibility CMS is considering for E/M visits
- Which broader fee schedule and reporting issues are included in the proposal
- How the article frames specialty, therapy, and non-face-to-face service changes
Who Should Read This
- Physicians
- Medical coders
- Medical billers
- Practice administrators
- Compliance staff
- Specialty practices
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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