Potential CMS Ruling Would Reduce Billing Burden But Could Harm Patient Care

CMS (The Centers for Medicare and Medicaid Services) proposed plan to reduce paperwork for providers in order to allow them to focus more on their patients. Due to come into effect in 2019 if approved, the AMA (American Medical Association) agrees that the Physician Fee Schedule will “improve patient-centered care and patient care access.” Documentation requirements have been viewed as an ‘administrative burden’ and have been causing providers to feel overwhelmed. The redundancy of information on each page of their current documentation has made it extremely difficult for health providers to quickly find data on their patient’s present illness or most recent test results, significantly lessening their quality of care. However, AMA and various healthcare groups within the industry have expressed concerns and proposals in order to ensure that this change will actually have the effect that it is meant to. The Goals of The Physician Fee Schedule Ideally, this new documentation process will eliminate: Any need for providers to include the patient’s history of health prior to their previous visit. The physician’s requirement to continuously re-document any patient data that has already been entered into the EHR. The requirement of providing justification for home care visits. Multiple payments and configure payment requirements into one bill. Questions and Concerns On The Proposal AMA supports some aspects of this proposal but is concerned that “physicians and other healthcare professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care,” would be negatively affected and they would ultimately jeopardize their patients’ access to care. It is widely acknowledged that the E/M service codes are extremely difficult to reconfigure, and AMA recommends that CMS comes up with a workforce to properly identify these issues and how to address them. This group would be given the task of coming up with the 2020 Physician Fee Schedule proposals. Concerns brought up by other medical groups include: It harms providers who are treating patients with complex needs and inevitably reduces patient access to care. This is due to the motion to have fewer billing codes, meaning there would be less specifications for those patients who require complex treatment. It harms providers who treat patients with multiple chronic conditions and will ultimately cause these providers to choose not to treat them due the difficulty the new proposal instills. It will result in more copayments and more time and travel costs for patients. What Does the Future Hold? The concerns discussed here were written in a letter addressed to the CMS from the American College of Rheumatology and 126 other patient advocacy groups. The letter, though acknowledging how the proposal is moving in a better direction, also addresses the negative effects it will have on specific health providers and the patients they care for. It concludes with a request that CMS will not “move forward with the proposal as it currently stands, and instead convene stakeholders to identify other strategies to reduce paperwork and administrative burden that do not threaten patient access to care.” Subscribe to our newsletter for more healthcare revenue cycle news updates like this one right to your inbox!