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Are your providers ready for new outpatient coding and documentation standards?

MGMA Stat - January 28, 2021


Coding & Documentation


MGMA Staff Members

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders, “Will your organization provide additional training to clinicians on the 2021 outpatient E/M changes?”
  • 89% said “yes.”
  • 11% said “no.”

Among respondents who noted training challenges:
  • Many noted that coordinating physician time for training was difficult, especially for those with physicians working at home.
  • Some practices facing staffing shortages while running vaccine clinics or having employees in quarantine expressed similar concerns with completing training.
  • Others noted that they are attempting to do training via email.

One respondent said that the practice’s coders and compliance teams are auditing all notes with new E/M CPT® codes charged for January and providing feedback to providers, as needed.

The poll was conducted Jan. 26, 2021, with 691 applicable responses.

Training and education are critical to a successful 2021 and beyond

Physicians and clinicians are now required to utilize a revised CPT® code set. The U.S. Department of Health & Human Services’ (HHS) Healthcare Common Procedure Coding System (HCPCS) is the U.S. standard medical data code set. Under HIPAA it is required that health plans use the most recent version of the code set, which went into effect Jan 1.

Numerous changes occurred between the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS), including the elimination of CPT code 99201, changes to the RVU values for E/M and other CPT codes, and a new documentation standard that requires a clinician to use either medical decision making (MDM) or time-based as the new documentation standard for services provided.

It’s important for medical practices to act now to ensure all providers are up to speed on these documentation methodologies. This will ensure that practices are compliant and able to be appropriately reimbursed for the services they have provided.

In addition, there were significant changes by CMS to the wRVU values of the E/M CPT codes and the Medicare Conversion Factor was decreased from $36.0896 in 2020 to $34.8931 in 2021. These changes will not only impact reimbursement but have implications for any physician whose compensation is tied to RVUs.

MGMA has a member-benefit 2021 E/M toolkit filled with resources and education to help practices get up to speed on these changes and their implications. This is in addition to MGMA Government Affairs’ support and advocacy efforts, other educational resources, a vast Member Community, Ask an Advisor subject-matter experts and expert consultants to assist practices with 2021 E/M changes or any other area of operational support.

Additional resources


Join MGMA Stat

Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message.

About the Author

MGMA Staff Members

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