Update on CMS Changes to Doctor Payments – Including Complex Patient Billing Codes

We are sharing this update on a previous ANCOR Capitol Correspondence story because of concerns expressed by ANCOR members about having difficulty finding medical providers willing to take on clients with I/DD, often considered complex patients.

As shared by Politico Pro:

“CMS has scaled back a proposal to overhaul Medicare physician billing codes after receiving fierce backlash from doctors.

In a bid to cut physicians’ paperwork, CMS this summer proposed shrinking the number of ‘evaluation and management’ codes for office and outpatient visits, which determine Medicare billing, from five levels to two. While doctors applauded the effort to reduce their administrative burden, many warned it would slash their payment for treating complex patients.

Responding to those complaints, the final physician fee rule released today preserves the billing code for the most complex patients and collapses the coding system into three tiers starting in 2021.

CMS Administrator Seema Verma on a conference call with reporters said the proposed rule received a ‘large number of constructive comments’ on the coding proposal.

The overhaul is aimed at upending a payment structure that had existed for two decades. The coding system required doctors to produce more documentation to justify higher levels of billing. But as time went on, doctors claimed the required documentation was burdensome.

Many specialty societies, however, voiced their concerns over the CMS proposal. They worried collapsing the codes to just two would mean doctors would get paid less for treating complex patients over long periods of time.

CMS also extended the implementation timeline to continue working with stakeholders. The American Medical Association applauded the final rule and the extra time.

‘A two-year window for implementation of the proposal will give the AMA-convened work group — comprised of physicians and other health professionals — time to make recommendations on this complicated topic,’ AMA president Barbara McAneny said in a statement.”