Part B Insider - 2017 Issue 7
Prolonged Services: MUE Takes Back Some Non-Face-to-Face Pay
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Article Overview
This article covers a CMS change to billing for prolonged evaluation and management work performed away from direct patient care, with emphasis on a medically unlikely edit and the resulting Medicare time-limit impact. It is relevant to surgeons, physician coders, and billing staff who track prolonged services, fee schedule updates, and documentation requirements for CMS claims processing.
Why This Topic Matters
The topic affects whether certain prolonged services can be reported on Medicare claims and how much time can be billed under the updated edit. It also highlights the need for documentation supporting the duration and content of the service.
Article Sections
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Background on CMS payment for prolonged services
Introduces the Medicare Physician Fee Schedule change and the broader policy context for billing prolonged non-face-to-face work.
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CMS update and medically unlikely edit
Summarizes the CMS edit affecting claims for prolonged services and the resulting limit discussed in the article.
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Documentation expectations
Notes the recordkeeping and documentation themes associated with reporting prolonged evaluation and management services.
What You Will Learn
- How CMS changed the billing landscape for prolonged non-face-to-face work
- What a medically unlikely edit means for reporting prolonged services
- What type of documentation is emphasized for these services
- How the article fits into Medicare Physician Fee Schedule updates
Who Should Read This
- Medical coders
- Billing staff
- Surgeons
- Physician practices
- Revenue cycle professionals
Codes Discussed
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