Use the next two years to prepare for new documentation guidelines and payment rates. On Nov. 1, 2018, the Centers for Medicare & Medicaid Services (CMS) finalized in the 2019 Physician Fee Schedule final rule significant changes to documentation requirements and reimbursement for evaluation and management (E/M) office visits (CPT® 99201-99215). The most significant changes ...
Let medical necessity point you to the correct answer. A few years ago, I presented to a family practice office as a new patient for a preventive medicine visit. I filled out all the necessary new patient forms, gave the receptionist my insurance card, and was promptly asked for a co-pay. I explained that my ...
In Billing
Dec 6th, 2013
This past summer, the Center for Medicare & Medicaid Services (CMS) issued notice that it was considering a radical change for emergency department (ED) and hospital clinic evaluation and management (E/M) coding. With the release of the 2014 hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System (ASC PS) final rule, that ...
Dec 2nd, 2013
Working within a group practice can alleviate many of the financial headaches encountered in a private practice, but it also can create new challenges—such as keeping track of new versus established patients. A “new patient” is one who hasn’t received any professional services, such as an evaluation and management (E/M) or other face-to-face service, from ...
Aug 1st, 2012
By Nancy Clark, CPC, CPC-I Modifiers are crucial in telling the story of the claim by identifying procedures that have been altered in some way without changing the core meaning of the code(s) submitted. Let’s look at the modifiers that can be appended to evaluation and management (E/M) codes used within the global period. The ...