January 18, 2018
By New England Accounts Receivable Management

It's always crucial to stay on top of the ever-changing regulatory framework and new policies surrounding medical billing. For example, in the year that just ended, ICD-10 medical coding has been implemented across the industry. That fact may not be headline-making in most walks of life, but for private medical practices keeping up to date on such changes to billing and coding requirements can be significant.

  • The new medical code changes that came out on June 11 for the 2019 fiscal year include 473 code changes. Out of these changes, 51 codes have been deactivated, 143 codes have been revised, and 279 new codes have been added. 
  • These new 2019 ICD-10-CM codes have been in effect since October 1, 2018 for patient encounters and discharges. 
  • New codes were added in Chapter 19, new codes and changes were made to Chapter 2: Neoplasm, and there are some new codes in Chapter 7 in the current CPT Coding Book.

For a small medical practice that already needs its staff to wear many hats, keeping up with timely and accurate billing can be time-consuming and complex. Worse yet, if the proper time and attention are not given to the billing process, you might end up losing out on a substantial amount of reimbursement dollars.

With the start of a new year, we thought it would be helpful to review how a few new wrinkles in the practice of medical billing and medical coding could impact private practices in 2019.

Part B Drug Payments Change 

Midway through 2018, the Centers for Medicare and Medicaid (CMS) proposed changing the way they pay for new drugs administered by physicians under Medicare Part B. At the time of this recent proposal, during the initial two quarters that a new medication is on the market, CMS would pay the wholesale acquisition cost (WAC) and a 6% fee to cover the cost of administration and office overhead. With the new proposed fee schedule for 2019, CMS proposes to cut this payment to the WAC plus a 3% fee to make the payment amount match the actual cost of the medication more closely.

Press reports reveal that, according to agency officials, the add-on payment that comes with these new medications has raised considerable concerns over the years because practices can raise more revenue from those percentage-based add-on payments for the more expensive drugs, and they fear that this opportunity to bring in more revenue may be an incentive for the use of medications that are more expensive. CMS also noted that this reduction will lower the out-of-pocket costs for beneficiaries, since the copayments are a percentage of the total cost of medications, including this add-on percentage. 

According to MDEdge, several groups have taken issue with this proposal, including the American College of Rheumatology (ACR) and the Community Oncology Alliance (COA). According to the ACR, they’re worried that this cut may “slow market uptake of biosimilars,” which could potentially hurt the efforts to lower drug prices. 

Changes in Telemedicine Coding 

Within the same new proposal, CMS is also working to increase telemedicine use. Medicare is going to begin paying for virtual check-ins, allowing patients to connect with physicians via video chat or phone. Such an approach, it is believed, holds the potential of delivering to patients the care they need, while avoiding unnecessary costs. 

Along with paying for virtual check-ins, the proposed rule will also allow for billing and payment when doctors review images texted to the office by a patient. CMS is expected to loosen its reimbursement of telemedicine services in 2019, which will lead to further telemedicine billing and coding changes for the coming year. 

Big Changes In Evaluation and Management Coding (E&M Coding)

Expect also to see some major changes in evaluation and management (E/M) medical billing and medical coding for 2019. In the push to reduce the administrative burden on providers, the new proposed documentation changes would give providers these new options: 

  • Instead of using the 1995 or 1997 E/M documentation guidelines, providers would be able to document outpatient/office E/M visits using time or medical decision making
  • Using time as the main factor when choosing a visit level even when care coordination or counseling dominates a visit
  • Reviewing and verifying some information in medical records that gets entered by beneficiaries or ancillary staff instead of re-entering this information
  • Focusing the documentation on things that have changed or pertinent things that haven’t changed instead of re-documentation of all information, as long as the provider reviews and updates previously entered information

According to a fact sheet the agency recently posted on the CMS website, they also want to streamline the E/M coding system by going with “new, single blended payment rates for new and established patients for office/outpatient E/M level 2 through 5 visits and a series of add-on codes to reflect resources involved in furnishing primary care and non-procedural specialty generally recognized services.”

As your practice prepares for the new changes coming for the 2019 year, you may decide that outsourcing billing and coding is a practical way to save time and money for your practice. NEARM specializes in medical billing and coding and offers a variety of other services to meet your practice’s needs. We invite you to contact us today to learn how our billing and coding services can help you enhance practice reimbursement revenue. 

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