My neighbor’s Christmas lights are already up– Can you believe 2021 is almost upon us? As the new year approaches, here are three things your medical practice should take care of before January 1, 2021.

Update Your EMR’s Office Note Template

Prepare for Evaluation and Management (E/M) Code Changes in 2021 by updating your EMR Office Visit Templates. In a nutshell, here are some of the E/M Code changes that go into effect January 1, 2021:

  • No more 99201. It’s been eliminated.
  • History and Physical exam no longer determines which E/M code to choose. (However, H&P may still contribute to total time spent.)
  • Physicians choose Medical Decision Making (MDM) or time spent as the basis for choosing the office visit code.
  • New MDM Criteria.
  • Changes apply to outpatient, office settings– not to SNFs, inpatient, or home visits.
  • Time can now include both face-to-face (F2F) and non-F2F time on the same date of service.
  • New add-on codes.
  • Social determinants of health, e.g. poverty and homelessness, can be captured as part of justification for higher level codes.

Consequently, you may want to update your EMR’s note template to better reflect the changes. (Keep in mind that while certain aspects of the notes may be deemphasized in terms of reimbursement, they may still be useful for liability or other considerations.)

Update Your ChargeMaster

Many practices base their charges on the Medicare Fee Schedule. Often, self pay rates have some relationship to current Medicare rates. There are compelling reasons to update these each year. In general, self-pay rates should be higher than Medicare reimbursement, or you’re theoretically overbilling Medicare (Caveat: this is charges, not taking into sliding fee schedule or charity care discounts).

In order to maximize revenue, your self pay rates should typically be higher than your best commercial payer’s reimbursement, or you may have to accept lower reimbursement from the payer—This is because most contracts will pay you the lesser of the payer’s fee schedule or your “customary” rate, which is arguably the self pay rate. So it makes sense to compare fee schedules and self pay charges, using the latest fee schedule amounts.

The 2021 Medicare fee schedule had not been uploaded to CMS’s Physician Fee Schedule Tool yet at the time of this blog. But you can check your Medicare Administrative Contractor (MAC). If you’re in “Rest of Florida,” you can check with FirstCoast Solutions. Medicaid rates often lag behind.

Refresh “Scripting” for Front Desk Staff

At the beginning of a new year, it’s helpful to remind your team to get new copies of insurance cards. Patients’ plans may have changed. With so much upheaval in 2020 (widespread unemployment, migration out states with Draconian shutdowns, etc.), you may find more plan changes compared to previous years.

Also, higher deductibles mean that practices receive zero-pay EOBs from insurers during the first part of the year. That makes it critical to collect patient responsibility up front. You can help your front desk team by providing scripting to help them successfully request payment. Also, offer as many payment options as possible. In addition to credit cards, directions to the nearest ATM, etc., consider a service like Care Credit that offers patients financing.

If you’re panicking over your to-do list and need some help, email or schedule a FREE Discovery Call from our webpage. We’re here to help your practice have a prosperous 2021.