MGMA18: No crystal ball prediction on what CMS will do about controversial E/M codes

Crystal Ball
Nobody's betting on what CMS will do in its final rule when it comes to E/M codes. (radiomoscow/iStock/Getty Images Plus/Getty Images)

BOSTON—It’s the big question on the minds of many in the physician practice world.

Will the Centers for Medicare & Medicaid Services (CMS) issue a final rule in the coming weeks that includes a controversial proposal to consolidate evaluation and management (E/M) billing codes? Critics say the change will leave physicians who treat high-acuity patients underpaid.

At a “Washington Update” session on Monday at the Medical Group Management Association (MGMA) annual conference here, the organization’s Washington insiders weren’t going out on a limb.

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“It’s basically a coin flip,” said Drew Voytal, an MGMA associate director for government affairs. “CMS received a lot of blowback on this.”

Indeed. The government agency received more than 15,000 comments, many of them about the E/M codes, when it asked for public response on its proposed rule to establish a physician fee schedule and set rules for year three of the Medicare physician payment program under MACRA.

“We will just have to wait,” Voytal said, about trying to predict the future on this one.

CMS is expected to come out with its final rule on Nov. 1. That would give physician practices just two months to plan and implement for any changes scheduled to take effect on Jan. 1, 2019.

RELATED: Good or bad idea? Some worry that E/M coding update could underpay doctors with sickest patients

And that worries Anders Gilberg, MGMA’s senior vice president for government affairs.

Anders Gilberg
Anders Gilberg
(Courtesy MGMA)

“If they move forward with the proposal on Jan. 1 as is, I think the result will be chaos,” Gilberg told FierceHealthcare. “At a minimum, they need to step back and think about the consequences.”

The MGMA isn’t the only group calling for CMS to do further studying of the issue. The American Medical Association, the country’s largest physician group, asked CMS to delay action on the proposed code change to allow a workgroup to develop an alternative by 2020. 

Although he’s been in meetings with top CMS officials, Gilberg said he’s also making no prediction on what the agency will do.

RELATED: More than 150 medical groups oppose CMS proposal to change E/M codes

CMS’ proposal would create a blended, single payment for patient office visits for levels two through five for new and existing patients. Practices that bill for many four and five level visits, which are for the most complex visits, will see a reduction in their Medicare payments.

While CMS has said the proposal will cut physician documentation time, pairing it with a reimbursement cut doesn’t make sense, Voytal said

In fact, the MGMA isn’t so sure CMS believes the proposal will save physicians as much time as it has touted. MGMA officials quoted from page 1,102 of the proposed rule itself.

“We note that stakeholders have emphasized to us in public comments that whatever reductions may be made to the E/M documentation guidelines for purposes of Medicare payment, physicians and non-physician practitioners will still need to document substantial information in their progress notes for clinical, legal, operational, quality reporting and other purposes, as well as potentially for other payers,” CMS noted.

“Furthermore, there may be a ramp-up period for physicians and non-physician practitioners to implement the proposed documentation changes in their clinical workflow and EHR such that the effects of mitigating documentation burden may not be immediately realized. Accordingly, we believe the total amount of time practitioners spend on E/M visit documentation may remain high, despite the time savings that we estimate in this section could result from our E/M documentation proposals,” the proposed rule reads.

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