Medicare Compliance & Reimbursement - 2020 Issue 10
News You Can Use: Evaluate CMS’ Proposed PFS, Manage Your 2021 E/M Expectations
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Article Overview
This article summarizes selected elements of CMS’s proposed 2021 Physician Fee Schedule that may affect evaluation and management reimbursement, telehealth availability, and prolonged service reporting. It is intended for coding professionals, billing staff, and clinicians who need to understand the scope of the proposal and track how Medicare policy changes could affect outpatient, cognitive, transitional care, domiciliary, and home-based services. The discussion also notes that CMS’s approach may differ from CPT® guidance in certain areas and points readers to official rulemaking resources and comment deadlines.
Why This Topic Matters
The proposal could change payment levels and reporting expectations for frequently used E/M services and related specialties. Understanding the scope helps organizations prepare for possible Medicare policy and coding workflow changes.
Article Sections
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Payment increases and conversion factor changes
Discusses proposed Medicare payment changes affecting common evaluation and management services and the broader fee schedule adjustment framework.
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Telehealth expansion continues
Covers the proposal to add selected services to the telehealth list and the possibility of additional telehealth-related changes.
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Prolonged service proposal
Summarizes CMS’s proposed approach to prolonged outpatient service reporting and notes the comparison with existing professional coding guidance.
What You Will Learn
- What areas of the proposed fee schedule are most relevant to evaluation and management services
- How the proposal may affect telehealth coverage for selected service categories
- Why the prolonged services proposal is drawing attention from coding professionals
- Where to find official CMS rulemaking materials and public comment information
Who Should Read This
- Medical coders
- Billing staff
- Compliance teams
- Physician practices
- Health system revenue cycle staff
- Clinicians involved in documentation and coding
Codes Discussed
Code Ranges Discussed
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