TIME IS 💰: 2021 E/M Changes for Outpatient Services: Observations + Tips for Week 1

OBSERVATIONS + TIPS FOR WEEK 1

Apparently, there was a sudden interest in this topic, and people found their way to my Blog post to read up, as viewership had a tremendous spike on January 5th. I hope some folks found my post to be helpful. Given that we just finished the first workweek, I wanted to add to the post the following observations and tips to increase understanding of these E/M changes, with the ultimate goal to leverage your knowledge to meet your goals for 2021. 

MASTERY OF 2021 E/M CHANGES –> BETTER BILLING –> IMPROVED REIMBURSEMENT –> INCREASED REVENUE + IMPROVED RVU PERFORMANCE –> BONUS/RAISE/PROMOTION

OBSERVATIONS

1. I feel an increased pressure to finish the charting on the day of the visit, given the new requirements within billing for time (only time spent on the date of the visit counts). My question is: Who is keeping track of this? If anyone knows the answer, please message me.
2. I’m glad that billing based on Medical Decision Making (MDM) has not changed, as having to relearn two things would definitely require additional mental bandwidth, which I do not have right now.
3. Being able to now bill for pre-charting, after-visit charting and other time spent around the encounter (such as phone calls to specialists) feels great. It’s about time that all of that additional time spent on the encounters is now counted and seen as valuable.
4. The new time requirements for each level of visit look daunting on paper, but aren’t that challenging to meet if you get a loose tab of your total time spent. For example, the time requirement for a 99214 in an established patient is 30-39 minutes, but here’s how I’ve been getting there easily:
   PRE-CHARTING/OTHER VISIT PREP = 5+ minutes
   TIME SPENT IN EXAM ROOM WITH PATIENT = 20 minutes
   ORDER PLACEMENT + FINISHING CHARTING = 5+ minutes
5. I’m glad that codes 99201 and 99211 are now gone, as I don’t think I EVER used them anyways.
6. Even though it doesn’t factor into the billing anymore, I still find a thoroughly performed and documented HPI to be a vital aspect of the visits. I don’t know if I’ll ever feel comfortable with letting some of this slide, as it gives me a sense of insecurity in my MDM, as well as makes me feel more vulnerable to potential litigation.

TIPS

1. If you’re not pre-charting already, you NEED to start. If you have to, spend time digging out and catching up, then stay motivated to be proactive and in more control of your days.
2. Do not feel bad if your billing may seem higher with the 2021 E/M changes, if you’re thinking that it may mean higher visit bills for patients. We, as clinicians, have been doing a massive amount of “extra” work that was deemed as worthless with respect to billing. Do not undervalue your time as a highly-trained medical practitioner. Think about this: When is the last time that you thought that a car mechanic, lawyer, financial advisor, politician, veterinarian or dentist allowed themselves to have their time and expertise undervalued? We are no different.
3. Post the new time, and maybe the MDM requirements, near your computer where you document the most frequently. Don’t try to memorize any of this stuff, just make it be within sight, and eventually it’ll become second nature with some repetitions.
4. Personalize your EMR to account for these E/M changes: Create speed buttons, add a “Time Statement” into your templates or whatever else it takes to make it so that you don’t have to think much about the billing. Here’s my personal “Level of Service” setup in Epic (please note the deletion of 99201 and 99211):

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) There are no conflicts of interest to report. 3) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

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