Author: Renee Berban

Shauna Baughcum, MSHA, CHC, CHPC, CPC
Assistant Director-Compliance

For the first time in more than two decades, the evaluation and management (E/M) office visit code set (99202-99215) is subject to significant changes, as public and private entities converged to create a new model of coding documentation and payment.

Critically, the documentation guidelines that support the code level selection have undergone a vast overhaul.  The old guard, embodied in the 1995 and 1997 E/M documentation guidelines, is fading into the sunset.

A new era is dawning on physicians, providers, medical practices, coders, billers, auditors, payers and other stakeholders involved in the enormous world of E/M office visits coding and claims reporting.

Starting January 1, 2021, you’ll find that previously vital components of code level selection-namely, the history and exam components-no longer factor into the coding decision-making.

Instead, determining a level of E/M will come down to one of two components:  Medical decision-making (MDM) or time.  While providers will be required to document the history and exam components as medically necessary, those components will no longer determine the level of an E/M service.

In addition to refurbished documentation guidelines, the sweepings E/M office visit changes that take hold January 1, 2021, make multiple code updates, with one core E/M code deleted and add-on codes tacked onto the coder’s arsenal.

What’s more, the payment landscape is set to tilt dramatically.  The Centers for Medicare and Medicaid Services(CMS), following the lead of the American Medical Association (AMA), made good on its longstanding objective to right-size payments for primary care practitioners and other medical specialties that report a sizable chunk of E/M services.  The E/M office visit code set was long considered undervalued in proportion to other elements of the Medicare physician fee schedule.

To that end, medical practices can expect a significant increase in Part B payments for E/M office visit encounters, particularly for the mid- to high-level codes (99212-99215) that comprise the established patient visit portion of the code set.  The four established office visit codes are on pace for an average 15% pay increase in 2021, according to the latest available fee schedule data.

To provide some background on E/M changes the new era of E/M coding and documentation emerged from a multiyear process.  In part, the changes sprouted as a result of a general conception that the old standards no longer adequately captured the work of today’s health care providers.

“Stakeholders have long maintained that all of the E/M documentation guidelines are administratively burdensome and outdated with respect to the practice of medicine,” CMS stated in the final 2019 Medicare physician fee schedule.

Through public comment periods that garnered tens of thousands of responses, providers and medical practice personnel “told CMS that they believe the guidelines are too complex, ambiguous, fail to meaningfully distinguish differences among code levels, and are not updated for changes in technology, especially electronic health record (EHR) use,” CMS added.

Under the previous E/M reporting structure, providers could use the 1995 or 1997 E/M documentation guidelines, which were the official guiding principles of CMS.  The 1995 and 1997 guidelines specified the medical record information within each of the three key components, such as number of body systems reviewed, that served as support for billing a given level of E/M visit.  The 1995 and 1997 guidelines were similar to the guidelines for E/M visits within previous versions of the AMA’s Current Procedural Terminology (CPT) codebook for E/M visits.  For example, the core structure of what comprises or defines the different levels of history, exam and MDM in the 1995 and 1997 guidelines were the same as those in the CPT codebook.

Yet differences between the CMS guidelines and the MA’s own coding rules remained.  For instance, the 1995 and 1997 guidelines include extensive samples of clinical work that comprise different levels of MDM that did not appear in the AMA’s CPT codebook.

Working in a loose collaborative, CMS and the AMA embarked on an effort to modernize the E/M office visit guidelines- and to do so in a cohesive way that sought to eliminate disparities in documentation guidance.

In the early 2019, CMS hosted a series of listening sessions of the proposed E/M office visit coding, documentation and payment changes.  As first, CMS has proposed bundling multiple E/M codes into the same level of service and payment amounts.  “Our goal was to continue to listen and consider perspectives form individual practicing clinicians, specialty associations, beneficiaries and their advocates, and other interested stakeholders to prepare for implementation of the office/outpatient E/M visit policies that we finalized for CY 2021,” the agency stated in the final 2020 Medicare physician fee schedule.  Ultimately, the agency retreated from its proposal to flatten E/M payments.

In response to CMS’ early proposals, the AMA established the Joint AMA CPT Workgroup on E/M to develop an alternative solution to the bundled payments proposal.  This workgroup developed an alternative approach for an effective date of January 1, 2021.  Specifically, the CPT Editorial Panel adopted revisions to the office E/M code descriptors, and substantially revised both the CPT prefatory language and the CPT interpretive guidelines that instruct practitioners on how to bill these codes.

CMS soon signed on the support of the AMA framework.  “The AMA believes its approach will accomplish greater burden reduction, is more clinically intuitive and reflects the current practice of medicine,” CMS stated in the 2020 fee schedule.  “We agree that the MDM guidelines as revised by the AMA/CPT represent a good first step in reducing burden and updating the different levels of MDM for the current practice of medicine.”

Ultimately, CMS gave the green light to the AMA’s new E/M model, signaling its intention to proceed with the changes during the 2020 and 2021 rulemaking periods.  That model, with a focus on MDM and time, is the basis for outpatient E/M coding moving forward.

The utilization trends of E/M visits comprise approximately 40% of allowed charges for services rendered under the Medicare physician fee schedule.  The subset of E/M office visits-that is, the 99202-99215 series- account for approximately 20% of allowed charges.  That utilization is linked to significant spending- about $25 billion, according to statistics from the AMA.

Within the E/M services represented in these percentages, there is wide variation in the volume and level of E/M visits billed by different specialties.  According to Medicare claims data, E/M visits are furnished by nearly all specialties but represent a greater share of total allowed services for physicians and other practitioners who do not routinely furnish procedural interventions or diagnostic tests.  Generally, these practitioners include primary care practitioners and certain specialists such as neurologists, endocrinologists and rheumatologists. 

In 2018, providers reported more than 264 million office E/M encounters, according to the latest available Medicare claims data.  The bulk of those, 233.9 million, were for established patient visits (the 99211-99215 code services), comparted to 30.3 million visits for the 99201-99205 series.

In April 2019, the relative value scale update committee (RUC) of the AMA provided CMS with the results of its review, and its recommendations for work relative value units (wRVU), practice expense (PE) inputs and physician time (number of minutes) for the revised E/M office visit code set.  During the 2020 rulemaking period, CMS adopted the RUC recommendations.  The outcome is a net pay gain for E/M office visits codes.

The payment outlook for 2021 and beyond reveals significant money moving around the budget-neutral Medicare physician fee schedule.  Many specialties, such as family practice and internal medicine, are expected to gain substantial pay increases as a result of the revalued E/M office codes. 

Yet concerns about the E/M fees, and their impact on other code valuation levels, remain.  During 2020 rulemaking period, many commenters expressed concerns about the redistributive impact of revaluing of the E/M office visits code set, particularly for practitioners who do not routinely bill E/M office visits.  Commenters suggested a number of strategies CMS could use to mitigate the negative redistributive impact, such as phasing the changes in over four or five years, capping increases or decreases, conducting claims-based analysis and working with Congress to ensure that these changes would not negatively impact the CY 2021 conversion factor.  “We understand commenters’ concerns with the magnitude of the redistributive adjustment necessary to budget neutralize the increased values,” CMS said.  However, the agency proceeded with its plan to redistribute allowable fees under the physician fee schedule.  Below are the projected 2021 E/M office visit payment rates.

Code	2020 Fee	2021 Fee (Proposed)	YTY Fee Change	YTF % Change
99202	$77	$69	-$8.19	-10.6%
99203	$109	$106	-$3.21	-2.9%
99204	$167	$159	-$7.73	-4.6%
99205	$211	$211	-$0.46	-0.2%
99211	$23	$22	-$1.20	-5.1%
99212	$46	$54	$8.00	17.3%
99213	$76	$87	$10.63	14.0%
99214	$110	$123	$12.48	11.3%
99215	$148	$172	$23.94	16.1%

We Simplify Your Workday!!!! On January 4th, Workday went live, and replaced the HR and Payroll portion of Lawson. This did NOT replace Kronos; you will continue to use Kronos as you have in the past.

In order to learn more about Workday, please take some time to visit The Workday Show on the Workday SharePoint Site which features the various Project Leads. You will learn more about the Workday processes that have been put into place and how these changes can simplify your life.

The Workday initiative is a UMC Health System venture. Instrumental in the Workday project from UMC Physicians thus far has been your HR Team, Accounting and Payroll, and Training and Education. All managers have had the opportunity to be trained on the basic Workday functions that they will use most frequently. However, there are many other processes and helpful tools for you to tap into as you become more familiar with Workday.

During the first week of January, when Workday went live, you were able to call the Command Center with questions. If you have any questions or want to provide Feedback, please visit the Simplify Your Workday SharePoint Site. You may also call Katy Ashworth in HR (761-0316) or Ginger Riewe in Accounting (761-0359) with questions. They will be able to direct you to the right person to help you with your questions.

I chose UMCP because I love to assist and provide hospitality to people, and I love children. I strive for excellence, and I aim to be a leader while being the best that I can be to my patients. I never know what a person is going through so if I can help make a difference I will.

Regina Skinner, Patient Rep, Wolfforth

I was working in the ER at UMC and wanted a change of pace. UMC treated me well and made me feel like I was right where I needed to be, which is why the transition to UMCP was very easy and obvious.

Eduard Tam, Medical Scribe, NW Pediatrics

I have heard so many positive things about UMCP, and on my first day of in-processing I knew I made the right decision. Everyone is so very kind and helpful and, I am so happy to be given the opportunity to work for a great company.

Sheri Fagan, Coder/Biller, Internal Medicine

I was in need of a job, and when I started doing research about UMCP all of the reviews stated that UMCP is a great place to work at. Also, family members reached out and told me how employees at UMCP are treated well and everyone that works there is a part of a family. This caught my eye, because I wanted to work at a place that I am respected by others, and a place that I love.

Tia Moya, Patient Rep, Float 

I chose UMCP because I wanted to be a part of something special. I went to UMC or UMCP when I was sick growing up. I loved it every time.

Kaveri Conatser, Patient Rep, Milwaukee

I chose UMCP because they provide various opportunities, and they make a great impact on many peoples’ lives.

Yadira Hernandez, Referral Clerk, Referral Center

I worked at UMCP before becoming a nurse. I knew I wanted to come back one day to a clinic setting. When the opportunity came, I jumped on it!

Amanda Sullivan, RN, Dr. Barker

I chose UMC because I was wanting a better job opportunity, and they are the number one company to work for. I plan to work here long term. I love to help others.

Melissa McAdams, Patient Rep, Float 

I am majoring in health care management at TTUHSC and wanted experience working in health care. I saw many UMC clinics in Lubbock and thought it would be a great company to grow in and learn from.

Nasia Kim, Patient Rep, SW Family Medical

It was an amazing option, and I felt like it would benefit me in college with my major. It was also a more reliable job, and I’m very happy to have the opportunity to work here.

Allyson Baeza, Patient Rep, KingsPark Urgent Care

I chose UMCP because I loved how the nurses and doctors apart of UMCP care for their patients. Therefore, I decided that I wanted to be a part of that.

Skyler Torres, CMA, Float 

I love UMCP because the Culture and interview process are very comfortable. This makes the transition process a lot easier!

Dr. Joshua Layer, Internal Medicine

I chose UMCP initially because I wanted to get my foot in the healthcare door. I am very blessed to be able to work here because it is apparent that they value their employees and their opinions.

Chloe Echevarria, Patient Rep, Float

I chose UMCP because I believe in the culture and mission of UMCP. It is important to work for a company you believe in.

Ralea Seagraves, CMA, Float

I chose UMCP because I was out of a job due to COVID, and I had heard wonderful things about the company!

Stephanie Pierson, Payment Specialist, Revenue Cycle Management

I have been going to the clinics as a patient ever since I was young, and I love it. Therefore, I wanted to join the team.

Bailey Adams, Patient Rep, Milwaukee

I chose UMCP because of their excitement and passion towards pediatrics. There are many kids who need a pediatrician and I hope to bless them. The physicians and nurses I have met through UMCP have been incredible. It truly feels like a family.

Dr. Arrington Madison, KingsPark Urgent Care

Every employee is very helpful and patient. The culture here is unexplainable. I started as a RN at the hospital and knew when I became a FNP there was nowhere else I would rather work. I want to be somewhere I am making a difference, and I can do that confidently at UMCP.

Sarah Cuneo, FNP, KingsPark Urgent Care

I felt it would allow me to continue to provide care in a culture whose foundation aligned with who I am as a person inside and outside of work. I worked for UMC for nearly seven years in the ER and I knew I wouldn’t get the same family experience anywhere else. I am thankful to be able to continue my career with such an amazing organization!

Benita Hernandez, FNP, Freedom Clinic

I chose UMC because the respect and compassion this company offers to patients as well as staff is amazing. I felt very welcome from the moment I came into my interview, and the staff is wonderful.

Jeanette Cedillo, Patient Rep, Float

I was once a patient and my care was top notch, therefore I wanted to be a part of that.

Shannell Alvarez, CMA, KingsPark Urgent Care

I chose UMCP because they are simply the best!

Amanda Tarango, Referral Clerk, Referral Center

Anytime I have ever needed care I would always go to UMCP because the people are great and knowledgeable. I also love what UMCP represents and stands for. When I graduated, I prayed for a career at UMCP, and the overwhelming joy I feel working here cannot be explained. I have a career where I am excited to get up daily and go be part of something wonderful. Thank you UMCP.

Elaine Cantu, CMA, I-27

I worked for UMC and I know it was the best place to work in Lubbock and probably anywhere for that matter!

Molly Bates, FNP, Float

HEADLINE NEWS: UMC Physicians takes top honors by being named # 1 in the 100 Best Companies to work for in Texas!

This year marks the 15th anniversary of the state-wide employer recognition program that awards employer groups for striving for excellence. The program is a survey competition to determine the best employers throughout the state. A joint effort by The Texas Association of Business (TAB), Texas Society of Human Resources Management and the Best Companies Group, an independent workplace excellence research firm, Texas employers can compete for annual rankings with other similarly sized companies.

How does the survey process work?

STEP 1: Employers complete an in-depth survey, detailing company policies, practices, benefits, and demographics.

STEP 2: Randomly chosen employees were selected to complete a “how do you feel about it” survey. The questions were responded to using a scale of five points ranging from “Agree Strongly” to “Disagree Strongly.” There were seven demographic and two open-ended questions.

The anonymous surveys were returned to the Best Companies Group for assessment. After all surveys were tabulated – the results were obvious . . .

UMC Physicians is officially the “BEST PLACE TO WORK AND THE BEST PLACE TO RECEIVE HEALTHCARE.”

A tremendous amount of strategic planning, implementing of employee ideas, and commitment to creating a workplace where employees are a top priority is how we earned this 1^st place reward.  

What makes UMC Physicians the  # 1 best place to work in Texas?

Among the many reasons that UMC Physicians is the best place to work in Texas are:

• A comprehensive benefits package
• Recognition of the individual strengths 
• Commitment to the communities that we live in
• Investment in professional development opportunities
• Peer and patient nominated program to recognize staff members who go beyond expectations 
• Quarterly visits by executive officers to clinics
• Monthly communication from Executive Officers
• Company-wide appreciation events
• Recognition of employee birthdays
• Employee satisfaction surveys
• Physician satisfaction surveys
• Years of service recognition

Congratulations to all UMC Physician employees for achieving this monumentous honor! 

The Change Champion Committee was created to prepare UMC and UMCP employees for the Workday change that UMC Health System has coming, beginning in January 2021. Workday is the system which will replace Lawson and offer all employees some great, new, easy-to-use options for the management of their UMCP account. 

These Champions have committed to meet regularly to assist with project rollout, act as consultants, provide feedback and support with the new system, and support the UMCP team through the change. They play a huge role in the success of this exciting new program. 

Meet our Change Champion Committee:

• April Pierson, Manager, Managed Care
• Karen Sawyer, Director of Operations, TeamChoice
• Gabe Bryant, Practice Manager, UMC Internal Medicine Associates
• Jessica Rosa, Practice Manager, The Office of Dr. Craig Barker
• Belen Morales, Patient Services Representative, Central Business Office
• Brianna Chavez, Specialist, Central Business Office
• Amanda Davidson, Practice Manager, Pediatric Associates of Lubbock
• Alecia Claxton, Operations Manager, Operations
• Barbara Condren, Operations Director, Operations
• Angelica Aguilar, Coordinator, Risk Management
• Rene Sellers, Coordinator, Accounting
• Maricela Chavez, HR Specialist, Human Resources
• Samantha Dominguez, HR Generalist

For more information on Workday, please read the Workday article in this issue of the newsletter.

I love working in healthcare, and UMCP is a great place to work. I’m happy to be back as a PRN.

Monica Picon, Patient Representative, Orchard Park

When I first was applying, I chose UMCP because of the benefits offered. Now that I have worked here for more than 3 months, I am glad that I chose this place because it is truly the best place to work in my 30 years’ experience!

Marcelina Rupley, MD, NW Pediatrics

I have experienced awesome care at UMCP, and I wanted to be involved in such a great atmosphere that exemplifies amazing values.

Mindy Prieto, CMA, Float

I was previously employed with UMC Health System, but then I moved. When I moved back, I knew I wanted to go back to the same culture that was so amazing to work for.

Karina Abrego, LVN, Pediatric Associates of Lubbock

I wanted to be an essential employee, and UMCP was a great place to be able to play a vital role in health care.

Brittney Delara, Patient Representative, Milwaukee

I chose UMCP because I enjoy interacting with patients. I love to be able to brighten someone’s day when they are feeling down or in pain.

Ana Nunez Padilla, Patient Rep, Float

I chose UMCP because of my own personal experiences related to my family’s healthcare. I saw the immediate difference in UMCP’s culture and service, and I knew I had to do everything I could to become a part of the team.

Sarah Gonzales, Specialist, Eligibility

UMCP has superior healthcare, as well as outstanding employee retention and satisfaction. Everyone knows the best place to work in Lubbock is UMCP.

Edna Bustos, Supervisor, Revenue Cycle Management

UMCP comes highly rated: I’ve always heard great things about UMCP and how it is a great place to work.

Jordan Burkhead, Patient Representative, KingsPark

UMCP has great reviews and has a reputation of being an amazing place to work.

Andrea Mendoza, Patient Access & Referral Manager, Referral Center

I followed Dr. D’Alise to UMCP, and I’m so glad I did! Our Operations Director, Julie Cruz, has made the transition so smooth. I am just so happy to be back at UMCP!

Kim Angerer, Coding and Billing, Neurosurgery Clinic

UMCP shows friendliness in all aspects, and I am grateful to be in a kind environment.

Rosa Ernst, Primary Care Follow Up, Central Billing Office

Medicine is my passion, and I wanted to work in an environment that has this same value, which UMCP showed.

Destini Jones, CMA, Float

I was looking for a new experience to see if I want to pursue a master’s degree in Healthcare Administration, and UMCP was a great choice!

Kristian Lara, Patient Representative, Milwaukee Family Medicine

I previously worked at UMCP and missed patient care. The atmosphere exemplifies respect and is patient care centered. I returned, and my hope is to remain here for a long time.

Macy McMahan, Nurse Practitioner, UMC Southwest Gastroenterology (SWGI)

I’ve heard nothing but positive things about UMCP, and I wanted to be a part of the team!

Rhea Allen, LVN, Shallowater Clinic

I appreciate UMCP and the way they have taken care of my family. UMCP is an amazing place, and I have only heard great things!

Ashley Barron, CMA, Float

UMCP has amazing reviews and has great values. I chose to work here because of the positive environment reflected.

Keeley Reif, CMA, Dr. Craig Barker

I’ve heard amazing things about UMCP. The WaitfromHome app is amazing, and I have used it many times. The people I know that work at UMCP enjoy it, because it is an amazing place to work!

Haley Thomack, Patient Rep, LakeRidge Medical Center