Read the fine print: Take a closer look at CMS policy efforts to reduce the administrative burdens of Medicare E/M services-Read the fine print

Read the fine print

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The Centers for Medicare & Medicaid Services (CMS) initiated policy changes on November 1, 2018, aimed at reducing administrative burdens associated with outpatient evaluation and management (E/M) services. These changes fit within the Patients Over Paperwork initiative, starting from January 1, 2019, with full implementation by January 1, 2021. Key goals include simplifying documentation for outpatient services under Medicare.<br /><br />Documentation is crucial for quality patient care and appropriate payment. Excessive documentation, coding, and payment practices have added burdens to providers, diverting time from patient care and leading to increased operational costs and physician burnout. Studies revealed that for every hour spent with patients, providers spend nearly two additional hours on electronic health records and desk work.<br /><br />CMS’s updated guidelines for 2019 focus on reducing redundant documentation. Physicians need to document only changes or new pertinent information since the previous visit, rather than repeating data that has already been recorded by staff or the patient. They are no longer required to document the medical necessity of home visits over office visits or re-enter information already present in the patient records.<br /><br />The new guidelines allow for updates in coding practices as endorsed by the American Medical Association (AMA). Medical groups express concerns that the proposed changes may affect reimbursement rates and care quality, particularly for complex patient cases. As a result, CMS delayed the implementation of some policy changes to 2021 and plans to refine the policies further.<br /><br />New documentation policies also include the advancement of virtual services, such as virtual check-ins and remote evaluations, to increase patient access to care. CMS’s changes reflect efforts to adapt to modern technological advancements and to streamline the administrative processes, thereby improving patient care and reducing unnecessary burdens on healthcare providers.

Keywords

CMS

Medicare

Medicaid

E/M services

Patients Over Paperwork

documentation

administrative burdens

virtual services

reimbursement rates

physician burnout