Evaluation and Management Services Will See Big Changes in 2021

Posted by Nancy Clements on Aug 5, 2020 4:00:00 PM

The Centers for Medicare and Medicaid Services’ recently announced that Evaluation and Management (E/M) visits will soon get some relief from burdensome coding and billing requirements. These billing and documentation requirements for E/M codes were established 20 years ago and have been subject to longstanding criticism from clinicians that they do not reflect current care practices and needs.

E/M visits make up 20 percent of the spending under the Physician Fee Schedule. CMS, the American Medical Association, and stakeholders have worked to simplify coding and billing requirements for E/M visits, and the changes will go into effect January 1, 2021. These changes are part of the Patients Over Paperwork initiative.

As a result of this change, clinicians will be able to make better use of their time and restore the doctor-patient relationship by spending less time on documenting visits and more time on treating their patients.

The Trump Administration and CMS have taken steps to “cut the red tape” by reducing burdensome regulations and removing regulatory obstacles that get in the way of providers spending time with patients.

An increase in payment rates for office/outpatient E/M visits in 2021 will reflect changes in the practice of medicine, recognizing that additional resources are required of clinicians to take care of the Medicare patients, of which two-thirds have multiple chronic conditions.

Prioritizing investment in preventive care and chronic disease management

The prevalence of certain chronic conditions in the Medicare population is growing, says CMS. For example, as of 2018, 68.9 percent of beneficiaries have two or more chronic conditions. In addition, between 2014 and 2018, the percent of beneficiaries with 6 or more chronic conditions has grown from 14.3 to 17.7 percent.

CMS is proposing to similarly increase the value of many services that are comparable to or include office/outpatient E/M visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, physical and occupational therapy evaluation services and others.

"The proposed adjustments, which implement recommendations from the American Medical Association, help to ensure that CMS is appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients, like primary care and complex or chronic disease management," said CMS. 

Providers and their staff can learn about all these changes in time for the January 1. Sign up for Practice Management Institute's 90-minute self-paced training: 2021 E/M Documentation and Coding Changes. This course will give you a good baseline knowledge for the upcoming changes. 

Topics: E/M coding, medical coding, evaluation and management