Report on Centre for Medicare Services

Report on Centre for Medicare Services

Article 1 

The Centre for Medicare Services issued a final rule On November 1, 2018, that includes payment policies, payment rates, and quality provisions for services that should be updated which came under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.  For 2019 and beyond, CMS is finalizing some of the policies. First being elimination of any document of the medical necessity of a home visit. Secondly, for any patient visit , the doctors should always check whether the patient is in the records and if yes then what is the history of the disease. Thirdly, for any patient visit which is already in the record, the doctor should not record it as a new visit rather update that he reviewed and updated the information. Lastly, removal of potentially duplicative requirements of medical records of patients.
From the beginning of 2021, the CMS introduce some of the payment, coding, and other documentation changes. First being the variation of payment should be reduced in for office. outpatient visits by maintaining a standard rate for all levels. Secondly, giving permission to doctors to document E/M office/outpatient visits using their experience of decision making.Thirdly, E/M office/outpatient levels from 2 to  5 visits, doctors are flexible to document their visit levels. Fourthly, practitioners will be documenting the medical necessity of the visit. Fifthly, the introduction of additional codes will be recorded for level 2 through 4 visits. Finally, adoption of extended code where doctors need to spend more time with patient as required 

Doctors should be separately paid for the brief communication technology like telephone or some other device to decide whether visit is required or not (Moore, Mullins, Solis & Hays, 2019).
1.    The changes in the 2019 Quality Payment Program were as follows: 
2.    2019 QPP will remove the MIPS quality measures
3.    MIPS expanded to clinical psychologists 
4.    Promoting Interoperability scoring has changed
5.    In MIPS who opted out in 2018 , can join in 2019.
6.    $500 million pool is available for extraordinary performance
7.    2015 Edition CEHRT should be used 

Article 2

Every year AMA sends updates to the Current Procedural Terminology (CPT) code to keep the medical documentation up to date as per evolving technology and practices involved. The coding had certain limitations which need to be considered. Firstly, two codes cannot be reported on the same day, AMA suggests dominant code should only be reported. Secondly, the new codes can be reported on the same day as an E/M service as long as they are both performed by different, qualified providers. Thirdly, interference codes cannot be reported for more than 16 minutes of service.
There were various changes or updates made in CPT like - Health behaviour assessment codes are not dependent on the duration of the assessment. Secondly, the new code 96158 should be used for the initial 30 minutes of the service and +96159 should be used to document additional time. Thirdly, new codes are applied to interference services and are billed for individual clients. Fourthly, specific codes should only be used for family health behaviour interference processes where the client is present. Last but not the least, some codes are used to report family health behaviour interventions where the client is not present. Changes to the Current Procedural Terminology code will take effect for all claims submitted on or after Jan 1, 2020.
To summarize the CPT codes offers doctors and other professionals a standard language for coding any services related to health. All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. There are 3 categories of CPT codes and meant to give the users a uniform and standard understanding of health care services (Huey, 2020).


Huey, K. (2020). Current Procedural Terminology Update for 2020 | Journal Of AHIMA.     Retrieved 26 April 2020, from    terminology-update-for-2020/
Moore, K., Mullins, A., Solis, E., & Hays, B. (2019). The 2019 Medicare Documentation,     Coding, and Payment Update. Retrieved 26 April 2020, from