The office manager has been assigned to present an overview of the 2021 billing changes implemented to the practice’s Family Nurse Practitioner (FNP). All team members should remain informed and updated, as these developments will significantly influence medical practice procedures. The CMS has carefully synchronized medical billing with the changing demands of healthcare providers. It is important to remember that these changes impact the entire patient care process, not just billing.
Differentiating New Patients from Established Patients
Anyone who has not received treatment from the doctor in the three years prior or from a doctor in the same field who is a member of the same group practice is considered a new patient. On the other hand, a long-term patient has recently gotten medical care from a doctor or another medical expert in the same network and field (Barbieri & Levy, 2020). This distinction ensures that services are billed appropriately and is essential for billing purposes.
Rationale for Choosing MDM or Time for E/M Codes
The documentation requirements for billing have been recommended to be streamlined by the Centers for Medicare and Medicaid Services (CMS). The foundation for measuring the relative worth of the service has switched from the cost of the service to the complexity of the Medical decision-making (MDM) or the overall amount of time needed to care for the patient (Barbieri & Levy, 2020). With this adjustment, the clinician’s decision-making process and the time invested in patient care are recognized as necessary. It emphasizes the standard of treatment more than the volume of documentation. Furthermore, it enables practitioners to put patient needs before paperwork.
Activities Allowed Using Time as the E/M Code
All time spent on the encounter’s calendar date will be considered for office visits and other outpatient services starting January 1, 2021. Considering the importance and difficulty of jobs that do not directly entail patient engagement, this covers face-to-face and remote labor (Barbieri & Levy, 2020). This development reflects how healthcare is changing, with more and more people using telemedicine and virtual consultations. Additionally, it honors the administrative duties that support patient care.
Three Elements Considered When Using MDM
The three main elements considered in MDM are the number and complexity of problems stated during the encounter, the quantity and complexity of data reviewed, and the likelihood of complications, illness, and mortality. These components give a thorough picture of the patient’s health (Barbieri & Levy, 2020). The invoicing is checked to ensure that it accurately reflects the scope and depth of the medical examination. They also stress the significance of rigorous patient assessment.
Four Types of MDM Recognized
There are numerous distinct E/M numerical codes, but the four primary types of MDM are simple, low complexity, moderate complexity, and high complexity. Each level has a unique set of standards and E/M numerical codes that correspond to them (Barbieri & Levy, 2020). These levels provide this gradient of care complexity, enabling more precise invoicing and assisting clinicians in making decisions.
Example of Patient Encounter for Each MDM Level
- Straightforward: A patient with a common cold.
- Low Complexity: A patient with controlled hypertension.
- Moderate Complexity: A patient with multiple chronic illnesses like diabetes and heart disease.
- High Complexity: A patient with multiple comorbidities and an acute exacerbation of one of their chronic conditions. These examples provide a clear picture of the varying levels of medical complexity (Barbieri & Levy, 2020). They serve as practical guides for clinicians when determining the appropriate billing code.
Element(s) of MDM Criteria Reinforcing the Example
The factors supporting the high-complexity example are the number of diagnoses or therapeutic options, the volume and complexity of the data to be processed, and the possibility of complications, morbidity, and mortality. These components offer a foundation for comprehending the breadth of the necessary medical evaluation (Barbieri & Levy, 2020). They also emphasize how complex medical decision-making is.
Reference
Barbieri, R. L., & Levy, B. (2020). Major changes in Medicare billing are planned for January 2021: Some specialties fare better than others. OBG Management. Web.