2021 Medicare and E/M Changes: A Refresher!

Lynn M. Anderanin

Lynn M. Anderanin

Lynn Anderanin, CPC, CPPM, CPMA, CPC-I, COSC, has over 35 years’ experience in all areas of the physician practice, specializing in Orthopedics. Lynn is currently a Workshop and Audio Presenter. She is a former member of the American Academy of Professional Coders (AAPC) National Advisory Board, as well as several other boards for the...
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120 Mins
Lynn M. Anderanin & Jill M. Young

Session I- 2021 E/M Guidelines: What's Changing and What you need to do to prepare! (60 Min)

For over 20 years the same guideline requirements have been used to determine the level of service for office and outpatient visits. Providers had concerns that these guidelines required some elements that were not necessary from a clinical perspective, not to mention the time it takes to document each visit. The Patients Over Paperwork Act joined together the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) to create new guidelines that allowed providers to spend less time documenting and more time administering quality care to patients. The new guidelines streamline the documentation for history and examination to only what is pertinent to that visit, allowing the level of service to be determined by time or medical decision making. These new choices allow providers to use them on a patient-by-patient basis for more flexibility in the documentation. Although these choices have been previously used, the requirements have been updated to meet the expectations of these visits in today’s medical practice. Because these guidelines are in the CPT® 2021, unless otherwise noted by the insurance company, these documentation guidelines will apply to all insurance companies.

Learning Objective:

Because these documentation guidelines are effective from January 1, 2021, all providers and staff that are involved with office and outpatient visits should be aware of the changes. Also, electronic medical records system templates will need to be updated to accommodate the new elements for documentation. This webinar by E/M expert Lynn M. Anderanin will review all the necessary elements for the choices of time and medical decision making for attendees to walk away with the understanding of how to choose the level of service based on the new documentation requirements.

Session Highlights:

  • New and revised CPT® codes for office and outpatient services
  • Medicare Physicians Fee Schedule Final Rule
  • What services are included when using the time to determine the visit level
  • Changes that have been made to medical decision making and the table of risk
  • Forecasting how the new documentation guidelines will affect revenue for visits
  • The new role history and examination will play in visits
  • The elements that make up the time option for documentation
  • Improved ways to count diagnostic tests for data
  • New vs established patients under these changes
  • New concerns from outside auditing by insurance carriers

Session II- Expert Insights on the CMS Medicare Coding Updates (60 Min)

Each year CMS/Medicare proposes policy changes for Medicare Payments under the Physician Fee Schedule(PFS) that are finalized by early December. Items such as the conversion factor are a part of this much-anticipated document along with other changes that affect payment to providers from Medicare in a variety of situations. The Final Rule for the PFS was released and addressed a significant number of items. Many of the waiver items that we are currently working under are continued through the end of the calendar year in which the Public Health Emergency (PHE) ends or December 31, 2021. Details of each and any exclusions or omissions will be discussed including a new Category of Telehealth codes. For 2021, there are significant changes to Office & Other Outpatient Services with the re-defining of 99201-99215 by the AMA. CMS/Medicare has released code numbers and additional information regarding their position on these codes including Prolonged Service codes.

Learning Objective:

The continuation of or lack thereof regarding waivers and specific services that are currently in use during the Public Health Emergency (PHE) is important information for offices. Planning for 1-1-21 and what options both a primary care office and a specialty office would have regarding their patients requires information that is contained in the Medicare PFS Final Rule for 2021. The objective of the webinar is to identify which of these services and waivers are available for providers in the new year and also after the end of the Public Health Emergency. Understanding CMS/Medicare’s position on some new codes that have been released by the AMA in CPT is as important to providers in looking ahead to what their practice model is in 2021.

Session Highlights:

  • Telehealth Visits
    • Which codes are being permanently added to the list of Category 1 services
    • What is Category 3 telehealth codes
    • Which codes are being added to this new category
  • Skilled nursing facilities frequency limitation changes for 2021
  • Services by PT, OT, SLP, and some mental health professionals have new codes to work within their remote revaluation of patients
  • Medicare‘s position on Audio-only calls outside the PHE
  • Clarifications to Remote Physiologic Monitoring Services
  • Continuation of waiver allowing certain Other Qualified Health Care Professionals to supervise diagnostic tests
  • Clarifications to the Visit Complexity code
  • Comments on modifications to the documentation requirements of physicians

Who Should Attend

  • Physicians
  • Advanced Practice Nurses
  • Nurse Practitioners
  • Biller
  • Coder
  • Office Managers
  • Practice Managers
  • Auditor
  • Claims Processor
  • Collector
  • Reimbursement Specialist
  • Claims Adjuster
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