decisionhealth Newsletters, Part B News - 2018 Issue 7 (July)
Single-fee E/M pay rates poised to take over for new, established encounters
Subscribe or sign in to view the full article.
Article Overview
This article explains CMS’s proposed changes to office and outpatient evaluation and management payment under the 2019 Medicare physician fee schedule. It is relevant to physicians, coders, billers, and practice managers who follow Medicare reimbursement policy, CPT evaluation and management visit reporting, and HCPCS add-on/prolonged service developments. The discussion focuses on proposed payment structure changes, the specialties and visit types most affected, and the introduction of new HCPCS code concepts tied to primary care, specialty care, and prolonged services.
Why This Topic Matters
The proposal could materially change reimbursement patterns for office visits and affect how practices track utilization, documentation, and revenue planning. It also signals shifting Medicare policy around visit-level payment, add-on reporting, and prolonged service coding.
Article Sections
-
E/M payment changes
Overview of the proposed Medicare payment approach for office and outpatient evaluation and management visits. Covers the broad policy rationale, affected visit groups, and reported utilization trends across new and established encounters.
-
Find new add-on E/M codes
Discussion of proposed HCPCS add-on codes related to evaluation and management services. Focuses on the general purpose of the new codes and the categories of care they are intended to address.
-
Prolonged services reportable at 30 minutes
Summary of the proposed change affecting prolonged service reporting in office or other outpatient settings. Covers the new HCPCS concept and its relationship to existing prolonged service reporting.
-
Office visit E/M pay rates proposed for 2019
Tabular presentation of proposed Medicare payment rates for new and established office visits. Provides a quick comparison of the code groups and revised reimbursement structure.
What You Will Learn
- What CMS is proposing for office and outpatient E/M payment under the 2019 Medicare physician fee schedule.
- Which categories of visit reporting and payment are affected by the proposed changes.
- What general types of new HCPCS add-on and prolonged service codes are included in the proposal.
- How the article frames the likely impact on different specialties and practice types.
Who Should Read This
- Medical coders
- Billers and reimbursement staff
- Physicians
- Practice managers
- Revenue cycle professionals
- Compliance staff
Codes Discussed
Code Ranges Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com