CMS proposes simpler Medicare documentation guidelines in 2019 fee schedule

The Centers for Medicare & Medicaid Services (CMS) is looking to use its annual update of the Medicare physician fee schedule to address long-simmering complaints with how the program requires physicians and other clinicians to document evaluation and management (E/M) visits.

CMS this week released its proposed rule on the 2019 Medicare physician fee schedule. Among other things, the proposed rule would allow physicians to do the following:

• Document office/outpatient E/M visits by using medical decision-making or time; alternatively, they could continue to apply the current 1995 or 1997 E/M documentation guidelines;
• Use time as the governing factor in selecting visit level and documenting the E/M visit, regardless of whether they spend most of the visit providing counseling or care coordination;
• Focus their documentation of history and exam on what has changed since the last visit or on pertinent items that have not changed, rather than re-documenting information; they would still need to review and update the previous information;
• Simply review and verify certain information in the medical record that is entered by ancillary staff or the beneficiary, instead of having to re-enter it.

CMS is also soliciting comment on how documentation guidelines for medical decision-making might be changed in subsequent years.

For payment itself, CMS is proposing new single, blended payment rates for new and established patients for office/outpatient E/M level 2 through level 5 visits as well as a series of add-on codes to reflect resources involved in furnishing primary care and certain non-procedural specialty services. CMS also proposes a multiple procedure payment adjustment that would apply when E/M visits are furnished in conjunction with other procedures. The proposed rule includes a variety of other proposals related to E/M codes. (For more information about the changes, see "Physicians' E/M coding and documentation burden could lighten in 2019 under CMS proposed rule.")

The proposed 2019 Medicare physician fee schedule conversion factor is $36.05, a slight increase from $35.99 this year. The proposed new conversion factor reflects a legally required budget neutrality adjustment to account for changes in relative value units.

CMS will accept public comments on the proposed rule up until Sept. 10. For those who don’t want to read the full rule, CMS has provided an abbreviated fact sheet.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians