{"id":6414,"date":"2018-11-04T11:51:30","date_gmt":"2018-11-04T16:51:30","guid":{"rendered":"https:\/\/systems4pt.com\/staging\/?p=6414"},"modified":"2018-11-09T09:58:55","modified_gmt":"2018-11-09T14:58:55","slug":"cms-final-rule-for-2019-if-youre-not-angry-youre-not-paying-attention","status":"publish","type":"post","link":"https:\/\/systems4pt.com\/staging\/cms-final-rule-for-2019-if-youre-not-angry-youre-not-paying-attention\/","title":{"rendered":"CMS Final Rule for 2019. If You\u2019re Not Angry, You\u2019re Not Paying Attention."},"content":{"rendered":"

CMS Final Rule for 2019. If You\u2019re Not Angry, You\u2019re Not Paying Attention.<\/h2>\n<\/div>

On November 1st<\/sup>, the CMS released its final rule relating to outpatient rehab payments for 2019.\u00a0 We\u2019ve listed the highlights of this announcement (the black font).\u00a0<\/span><\/p>\n<\/div>

This outtake from the final rule attempts to simplify\/speed up documentation.\u00a0<\/span><\/p>\n<\/div>

    \n
  • For established patient office\/outpatient visits,\u00a0when relevant information is already contained in the medical record, practitioners may choose to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and need not re-record the defined list of required elements if there is evidence that the practitioner reviewed the previous information and updated it as needed.\u00a0\u00a0Practitioners should still review prior data, update as necessary, and indicate in the medical record that they have done so;<\/li>\n
  • Additionally, we are clarifying that for E\/M office\/outpatient visits,\u00a0for new and established patients for visits, practitioners need not re-enter in the medical record information on the patient\u2019s chief complaint and history that has already been entered by ancillary staff or the beneficiary.\u00a0The practitioner may simply indicate in the medical record that he or she reviewed and verified this information<\/li>\n<\/ul>\n<\/div>

    These instructions aim to simplify note-taking.\u00a0 Paraphrasing:\u00a0 The therapist does not need to write a book for each patient visit. The therapist does not need to rehash what was already documented on earlier notes.\u00a0\u00a0 The therapist simply needs to document what changed, relative to the selected functional deficit.\u00a0<\/span><\/p>\n

    Systems 4PT is the only leading EMR that allow point-of-care documentation.\u00a0 Following our daily visit workflow, when the therapist is done treating the patient, the note is signed.\u00a0 The approach to documentation defined by CMS, above, is precisely how our EMR flows.\u00a0 In fact, Systems 4PT highlights the most-clinically relevant functional deficit in the daily note, enabling a quick update of progression, which is obviously what matters most.<\/span><\/p>\n

    The next topic relates to a major change in how the CMS will reimburse outpatient rehab.\u00a0 The proposal is that beginning in 2021, patients\u2019 diagnoses will be stratified into different levels of severity.\u00a0 Documentation for less severe patients will be minimized and will receive a fixed reimbursement.<\/span><\/p>\n<\/div>

    Beginning in\u00a0CY 2021, CMS\u00a0will further reduce burden with the implementation of payment,\u00a0coding, and other documentation changes. Payment\u00a0for E\/M office\/outpatient visits will be simplified and payment would vary primarily based on attributes that do not require separate, complex documentation.\u00a0Specifically for CY 2021, CMS is finalizing the following policies:<\/p>\n

      \n
    • Reduction in the payment variation for E\/M office\/outpatient visit levels by paying a single rate for E\/M office\/outpatient visit levels 2 through 4 for established and new patients while maintaining the payment rate for E\/M office\/outpatient visit level 5 in order to better account for the care and needs of complex patients;<\/li>\n
    • Permitting practitioners to choose to document E\/M office\/outpatient level 2 through 5 visits using medical decision-making or time instead of applying the current 1995 or 1997 E\/M documentation guidelines, or alternatively practitioners could continue using the current framework;<\/li>\n
    • Beginning in CY 2021, for E\/M office\/outpatient levels 2 through 5 visits, we will allow for flexibility in how visit levels are documented\u2014 specifically a choice to use the current framework, MDM, or time. For E\/M office\/outpatient level 2 through 4 visits, when using MDM or current framework to document the visit, we will also apply a minimum supporting documentation standard associated with level 2 visits. For these cases, Medicare would require information to support a level 2 E\/M office\/outpatient visit code for history, exam and\/or medical decision-making;<\/li>\n
    • When time is used to document, practitioners will document the medical necessity of the visit and that the billing practitioner personally spent the required amount of time face-to-face with the beneficiary;<\/li>\n<\/ul>\n

      CMS believes these policies will allow practitioners greater flexibility to exercise clinical judgment in documentation, so they can focus on what is clinically relevant and medically necessary for the beneficiary. CMS intends to engage in further discussions with the public to potentially further refine the policies for CY 2021.<\/p>\n<\/div>

      The proposal states that for lower complexity deficits, therapists will be paid a single rate.\u00a0 Note that 75% of the patients (levels 2 through 4) are considered low complexity and only level 5 maintains the current payment rate \u201cto account for the care and needs of complex patients.\u201d<\/span><\/p>\n

      What\u2019s going on here?<\/span><\/p>\n

      Is it accurate that 75% of your caseload is not complex?<\/span><\/p>\n

      And what is this \u201cSingle Rate\u201d payment that will be used for 75% of treatments?<\/span><\/p>\n

      We can find a hint in a 9\/18\/18 APTA article \u201cAPTA, Other Healthcare Leaders Call for CMS to Rethink Evaluation and Management Payment Plan.\u201d\u00a0\u00a0 The article emphasizes the concept of \u201cpatients over paperwork.\u201d\u00a0 No one would argue against that, right?<\/span><\/p>\n

      The article discusses a proposed 5-level complexity system accompanied by a new reimbursement approach.\u00a0 Quoting the APTA, reimbursement levels for lower complexity patients \u201cwill see reductions based on the 2019 proposed relative value units. However, CMS argues, the reduced paperwork burden would offset the payment drop.\u201d<\/span><\/p>\n

      Lower-complexity patients will soon receive lower reimbursements.\u00a0 All of which is touted as progress because of lower documentation requirements.<\/span><\/p>\n

      Systems 4PT\u2019s assessment is that the APTA is tone deaf and disconnected from the realities relating to both private practice and EMR technology. Documentation with state of art EMR is getting increasingly faster. There is no need to lower documentation requirements (and payments).<\/span><\/p>\n

      Our concern is that the APTA seems to be willingly encouraging LOWER reimbursements for the majority of patient visits, in return for addressing these problems that have already been solved.<\/span><\/p>\n

      If you\u2019re not angry, you\u2019re not paying attention.<\/span><\/p>\n<\/div>

      Signup for More MIPS and CMS Updates or<\/strong><\/p>\n

      Request a Demo and See How Systems 4PT can Help Your Clinic<\/strong><\/p>\n<\/div>[contact-form-7 id=\"5393\" title=\"Free Demo_copy\"]<\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":6415,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[56],"tags":[47],"class_list":["post-6414","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general","tag-mips"],"yoast_head":"\nCMS Final Rule for 2019. If You\u2019re Not Angry, You\u2019re Not Paying Attention. - Systems4PT<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS Final Rule for 2019. 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