Gauging the impact of CMS changes on coding & billing.

Are the CMS changes good for our practice?
With so many CMS changes to coding, billing, fee screens and settings for approved medical service provision it may be difficult to discern whether the changes announced over the last few months have positive or negative impact on coding, billing and health care operations, the answer to the question is it depends who you ask.

CMS began the process of reviewing and revising fee schedules, how and where medical care was being provided long before the Pandemic hit.  Suddenly, an important and late-to-the-party agenda item was facing CMS Administrators: how to fund care for those afflicted by COVID and how to modify existing CMS policies regarding testing, monitoring, site visits vs telehealth, vaccine administration among other related topics.

Positive aspects of the 2021 changes:
1. Expansion of telehealth as a recognized medical care delivery system.
2. Creation of AMA Codes to cover Covid related care.
3. The opportunity for PCP's to receive more compensation for complex pts.

Challenges presented by 2021 changes:
1. Expansion of services outlined above resulted in an overall reduction in relative value units (RVUs) by an average of $3.68.  This means reimbursement for some CMS funded services will be lower in 2021 by an average of $3.68 compared to 2020.
2. There will continue to be a telehealth and Covid care learning curve for coders, billers and administrators that may result in a slower turnaround in paid claims.
3. Some EMR billing software companies are adjusting to the myriad of changes better and faster than others, incorporating changes and providing training opportunities for their client's billers and coders. 

With so many CMS changes to coding, billing and fee screens, 2021 will likely be a year of learning as we go and incorporating new best practices as a result of what we've learned... stayed tuned!

For more information visit: www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1