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3 Medical Billing and Coding Changes to Expect for 2019

September 18, 2018

Medical Billing Issues

In July, the proposed initiatives for the 2019 Medicare physician fee schedule was announced by the Centers for Medicare & Medicaid Services (CMS), and the officials announced that one of their goals was to work on easing the administrative burden on providers. According to Seema Verma, the CMS administrator, one of the things that she constantly heard as she traveled the country and visited clinicians in various care settings was that “…time spent on paperwork is time away from patients…” After hearing this story repeatedly, CMS is working to make some changes that will improve the lives of providers while improving access and quality for patients. Here’s a closer look at some of the proposed billing and coding changes you may see for 2019. 

 1 – Part B Drug Payments Change 

CMS is proposing the way they pay for new drugs administered by physicians under Medicare Part B. Currently, during the initial two quarters that a new medication is on the market, they’ll 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. 

According to agency officials, the add-on payment that comes with these new medications has raised some concerns in recent 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. 

2 – Changes in Telemedicine Coding 

With the 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. This has the ability to get 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. 

3 – Big Changes Evaluation and Management Coding (E&M Coding)

Expect to see some big changes in evaluation and management (E/M) billing and 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 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.”

Other Important Things You Need to Know for 2019 

The CDC has also recently published the new ICD-10-CM code changes for 2019, and here are a few of the important things you’ll need to know for the coming year. 

  • The new code changes that came out on June 11 for the 2019 fiscal year include 473 code change. 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 should be used beginning 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. 
  • You can download the new 2019 ICD-10-CM files in both XML and PDF formats. 

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


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