Physician groups satisfied with improved payment for E/M codes, reduced documentation in new Medicare rule

Up in arms a year ago, physician groups found a lot to like in Medicare’s new approach to evaluation and management (E/M) services finalized in the 2020 physician fee schedule.

Overall, the major organizations that represent physicians were satisfied with the Centers for Medicare & Medicaid Services (CMS) changes to E/M codes included in the Medicare final rule released Friday.

The American Medical Association (AMA) which worked with CMS to modify the E/M code changes, said the final rule achieves the first overhaul of E/M office visit documentation and coding in more than 25 years.

“This new approach is a significant step in reducing administrative burdens that get in the way of patient care,” said AMA president Patrice Harris, M.D. “Now it’s time for vendors and payors to take the necessary next steps to align their systems with E/M office visit code changes by the time the revisions are deployed on January 1, 2021.”

The American College of Physicians (ACP) agreed that CMS had come up with changes that would improve payment for E/M codes and reduce documentation burden.

“Medicare has long undervalued E/M codes (office visits) by internal medicine physicians, family physicians and other cognitive and primary care physicians. At the same time, physicians were faced with excessive documentation requirements to be paid for such services,” said Robert McLean, M.D., ACP president.

Physician organizations were happy CMS backed away from modifications it proposed last year to overhaul E/M codes that would have paid physicians the same amount for an office visit even when caring for the most complex patients. Faced with intense opposition, CMS last fall put the streamlining of E/M payments on hold in order to work with physician groups.

The AMGA said the changes CMS finalized acknowledge differences in patient complexity by maintaining separate coding levels, rather than paying a blended rate. 

Physician groups were opposed to CMS’s initial proposal last year which would have collapsed E/M levels 2 through 5.  The AMGA said it was pleased CMS reconsidered its 2019 regulation and in this year’s final rule opted to assign a separate payment rate to each of the office and outpatient E/M visit codes and finalized its proposal to maintain the level 1 visit code for established patients.

AMGA recommended this approach, as the level 1 code helps facilitate a team-based approach to care delivery and allows various members of the care delivery team to develop a relationship with a patient.

“A team-based approach to care requires an infrastructure to support it,” said Jerry Penso, M.D., AMGA president and CEO. “It also requires the right policies and a payment system that will maintain that infrastructure. This change goes a long way to helping our members deliver the best possible care.”

If there was one area that AMGA did not like, it was CMS’ changes to the Merit-based Incentive Payment System (MIPS). Instead of the chance to earn up to a 9% adjustment on Medicare Part B payments in 2022, CMS estimates the overall payment adjustment will be 1.4%, the AGMA said.

“While not every provider will achieve the highest possible adjustment, CMS’ continued policy of excluding otherwise eligible providers from participating in MIPS makes it impossible to achieve substantial payments to cover the cost of participation. Thus, AMGA members have expressed that the program is no longer a viable tool for transitioning to value-based care,” the group said.