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Understanding Why 99201 Will Be Deleted in 2021

outsource medical billing services

By Arslan ShahPublished 3 years ago 3 min read
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Walking out of 2020, and into 2021 – we are faced with a lot of different changes. Be it lifestyle, or the healthcare industry.

You may already be aware of the fact that the proposed Medicare Physician Fee Schedule rule for 2020 had been published on August 14th, 2019.

There are numerous facets to the rule – which includes a proposed change in the PFS conversion factor for $36.09, the addition of several brand new HCPCS codes for a bundled episode of care treatment – particularly for opioid use disorders, the modification of physician supervision requirements for physician assistants, as well as changes to permitting the review and verification of clinical documentation that is made by other physicians, residents, students, nurses or even other members of the medical team.

There are also other more substantial changes that involve the payment and documentation for the use of management and evaluation coding, for instance, both established patient visits as well as new patient visits.

40% of the allowed charges for PFS services are depicted by E & M services. Whereas 20% of all charges that are allowed for paid for professional services are represented by office/outpatient E & M services. But there is a lot that has changed since the MPFS Final Rule for 2019.

The American Medical Association (AMA) took some time and went on to create the AMA CPT Workgroup on the matter of Evaluation and Management Coding. This structure was able to carve out an alternative approach to the framework of the Centers for Medicare and Medicaid Services – reported in the MPFS final rule for 2019.

Based on this work, a summary of recommendations was adopted, officially, by the American Medical Association (AMA) in April, 2019. It will be implemented for CPT, on January 1st, 2021.

CMS has also chosen to review the work of the AMA CPT Workgroup and has been able to settle on a vast majority of the changes that are to their liking, and has also submitted all of these changes in the 2020 Proposed Rule.

The coming year may also be the best year for practices and medical organizations to begin thinking about the option to outsource medical billing services. It is far less time consuming, takes a huge responsibility off your shoulders, and enables a third party to do their absolute best at the task they specialize in – expanding business growth.

Given below is a basic summary of the proposed E & M changes in codes for new patient visits as well as established patient visits, from Jan 1st, 2021;

1. 99201 is to be deleted. The reasoning revolves around the basis that both 99202 and 99201 are associated with a very targeted, straightforward decision- making in the medical realm.

2. Physical and history examinations will no longer be considered parameters for the level of service selection. The provider would still be held responsible for documenting all the appropriate and medically necessary history – however, these portions would not be taken into consideration when determining the level of service.

3. Medical decision making will become the determining factor in the level of service selection. However, the proposed definition of time is now different, which includes the total face to face as well as non face to face time devoted to patient care activities.

Among some others, but this is a clear explanation of why 99201 will be deleted in 2021.

Billing freedom is a top tier medical billing company, that puts forth customized solutions for your practice, accompanied by a team of experts, that ensure they know the in’s and out’s of your enterprise before settling on the perfect solution, aligned with your values.

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About the Creator

Arslan Shah

I am a Guest Blogger and love to write blogs on valuable topics.

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