2019 Documentation Changes

Can anyone provide any guidance on how your company will be handling 2019 Medicare Physician Fee Schedule change regarding practitioners not needing to re-record the defined list of required elements if there is evidence that the practitioner reviewed the previous information and update it as needed?

Does this include both history and exam elements? Also, if the practitioner does state that they have reviewed prior data, and nothing has changed since the last visit, would you count those history and exam elements from the previous visit that have not changed for the current date of service?

When CMS states "what has changed since the last visit" what are you considering the last visit to be? Would the last visit be the immediate previous visit that took place or would the last visit apply to visits from 2 or 3 visits ago? I am worried that this new guideline will cause the providers to feel like they can put this on every single note causing a domino effect that would make one have to go back multiple visits to find the note they are actually referring to.


  • I'm also curious to know how medical practices are approaching the E/M documentation changes. According to a Part B News survey, few practices stated they would make significant changes to their current workflow. But why?

    As background, here's an excerpt from a recent PBN article:

    "A snapshot of responses from the Part B News 2019 Predictions Survey, conducted in early December, found that nearly three-quarters, or 73%, of respondents’ medical practices planned to essentially ignore the optional reporting changes when conducting and charting their bread-and-butter E/M services.

    Roughly 9% of respondents said their providers planned to take advantage of not having to re-record the chief complaint or history elements of the services in the EHR, while 5% reported they would not re-enter the exam information.

    The survey results suggest that a massive, game-changing trend in burden reduction will hardly sweep the nation’s medical practices in the new year. “I can’t imagine practices are really going to make a change,” says Betsy Nicoletti, president of Medical Practice Consulting in Northampton, Mass.

    The reason doesn’t appear to be a lack of desire to achieve administrative easing among practices, but rather a lack of opportunity to do so. In other words, the changes coming down the pike simply don’t move the needle.

    “I don’t believe this change will make a difference for us,” says Kris Keith, administrator with Brookings Harbor Medical Center in Brookings, Ore. “We have two clinics under one roof which share an [EHR]. Our mid-levels have their own patient assignment. In our [EHR], with one click, you can import the history, so [this is] not a big time-saver.”

    Full story here: https://pbn.decisionhealth.com/Articles/Detail.aspx?id=529135

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