UCR 18: E&M 2021 Preparation Checklist - The 7 steps you need to take to ensure a smooth transition

August 14, 2020

Mark, Ray and Scott discuss the 7 steps your practice needs to take to ensure a smooth transition to the new E&M rules in 2021.

  1. Choose a transition captain 
  2. Update Compliance Plan
  3.  Train the team
  4. Update Processes
  5.  EHR Template Update, Testing and Training
  6.  Estimate Financial Impact
  7.  Schedule Ongoing Training and Review

Upcoming E&M 2021 Live Online Workshops

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Dates (all times Eastern)

September 18, 2020 - 5:00 pm 

September 26, 2020 - 10:00 am

October 1, 2020 - 6:00 pm

October 2, 2020 - 5:00 pm

E&M 2021 Preparation Checklist

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Scott 0:00
Welcome to the urology coding and reimbursement Podcast, where we help urologist and staff achieve peak economic and practice efficiency. So there is time and energy, focus on patient care, and a happy life. I'm your host, Scott painter with my co hosts, Mark painter and Dr. Ray Painter.

Welcome to Episode 18 of the urology coding and reimbursement podcast. I'm your host, Scott painter with my co host, Mark painter and Dr. Ray Painter. And today we're going to go through the steps that you're going to need to take in order to prepare for e&m in 2021. Mark is going to walk you through the checklist. And we'll also put a copy of this that you can download on our podcast web page. So you can go to prs network comm forward slash 018. And you'll be able to get a copy of this checklist. But we've boiled it down to seven steps that you're going to need to make sure you have an accomplished before you can really make it a smooth transition to 2021 with your with regards to e&m coding. So, with that, I'm going to turn it over to Mark Ray, do you want to say anything to begin with? Or should we let Mark dive in?

Ray 0:19
No, actually, I will say that this is kind of brings back the old days when we were first going into the new system in 1992. We had a year to prep and get ready for it. And this is like a new system that you need to get ready for, although it's not totally new.

Mark 1:45
Alright. Yeah, it does. There's a little bit of that flavor and, and, and again, not on the same grand scale but a little bit like getting ready for ICD 10, which we did a few years ago. So it is is a it is a big change. It is a fundamental change that's coming down the pipeline for the e&m codes and you heard in our podcast, last in the podcast 17 depending on when you listen to it, but the changes that are coming down the pipeline for e&m codes are going to have a big impact on a few different things. In your practice, not only are is are these changes, going to be something that you need to learn just so you can pick the right code, but the values that were assigned to those is shifting a lot of money from surgery, and some of the other things that you do into the nm code. So you're really going to need to pay attention to these changes from a revenue standpoint, and when you look at at what the possibilities are in the changes from a from an actual functional standpoint. Also now got a tremendous opportunity to change the way the office flow works. So that you can actually potentially streamline the way the patients are coming through the practice, make it a better patient experience and make it a better experience for you because we're getting rid of some of the administrivia and click box stuff that we had to do. So, we we do think that this, this change is going to be a good one overall. But as with any change, you need to prepare for it and and therefore it's not going to be just a quick button, easy to move around. So you do want to you do want to prepare for it. And once again, we will provide you some opportunities to prepare. We do have now set up on our website, three below for upcoming webinars. To get you started in the preparation and ultimately included with each one of those is going to be some, some handout information, updated pocket cards and wall charts. A few other things that Scott has up his sleeve to, to help you in getting ready and actually maybe survive every single day was a little swag bag he's calling it and then and then if or no so and then probably a quick update webinar or announcement that we that will provide you at the end of the year with any potential changes that are out there. So you know, this is something that we're gonna we're gonna keep you up to date on and give you some practice scenarios throughout the year to help you really get ready to run when when January one comes around So, as you may remember from the last one kind of the big changes we're coming up against is the definition of time is going to change. You're no longer going to need to do the history and physical that you you used to do or have to do right now. And everything is going to be based on either time or medical decision making. And they're updating the way we're going to score medical decision making. The biggest changes are in the presenting problem and the data and the data scoring that we're going to have to do. So we've got all the pocket cards and wall charts kind of redesigned, so that we can update those going forward with you so you'll get your tools. So we have developed, I think, a reasonable check checklist that will be attached this podcast that you can download, and we will be providing some updates as we're going forward. To get to get you ready, so I'm just kind of run through a couple of different things. Number one, the prs schedule. So we will going to put we are going to put our, our, our checklist up next week, then we'll put a quick

webinar are up to really kind of go over some of the very high level stuff, the impacts that you're going to do, giving you some details of what's what's coming up in the in the full three hour webinar. And then we're going to run that webinar live four different times. Those dates will be listed on the website. You can go there and check the times and register right away so you can get all the information sent to you. So, what you can start doing, in addition to check it out how to get all the training and the information prs is download the checklist. And there are some important things that you need to start number one, just like we did with ICD 10. You need a champion assigned in the practice, you've got to have somebody who's your go to your pivot point. That's really coordinating, who's going to get training? Who Well, first, who needs training? Second, who's going to get training? What level of training do they need to get? Who needs repeat training? So you need a champion, a coordinator on site. Next, you're gonna want to update your compliance plan. You know, we've been running with the same evaluation and management code rule set for what is it 23 years 1997 was the last documentation guideline change we ran up against? And, you know, we did have a little bit of back and forth so you could probably say, we've been in the current guidelines set since about 19. 98, about halfway through when CMS came out saying you could use 95 or 97. But But after that we really haven't had any big changes to the rules. We've had tweaks and how things have been interpreted, that we've had to adapt to. But we haven't had that big change for a long time. So your compliance plan, which was probably built on making sure that new people were trained, and that your evaluation and management code reviews were occurring every six months or a year, you're going to want to in the very beginning, as you set things up, to actually build a little more aggressive education program into your appear compliance plan. And you're going to want to update all your compliance tools for your e&m code. So, you're going to want to update the compliance plan. And remember, the focus of a compliance plan should be To maximize your income by making sure that you are charging appropriately for everything that you do. And that really includes, you know, training and making sure that you're documenting everything that you actually do. And the compliance plan should be a supplement to that not a punitive plan that you're trying to beat everybody into submission with, it should be a revenue generation plan. Next, you really want to train the team, that, that team training is going to be very important. You may have multiple levels and and a lot of you have this in your offices where you have some internal champions that take the training, and then you may want to expose even your everybody to some high level training, but keep those internal champions to be the group that that people circle back to that really are the ones in charge of the compliance program and the office. It or chart reviews, and the systems that you're going to do that. So make sure that you've got those people in place and well trained and then regardless of who your training team is, and that may not be your clinical staff for the 100%, although we do recommend you put some of your clinical staff on your training team, to then train the team. You want to go back and update your processes and how you're doing, your your patients, how you're collecting information from your patients, how they're moving through the office. Now, you no longer have to have that full history and physical examination for every single patient. So what what does that do to your patient encounter? You're probably still going to need to pick up vitals based on the MIPS program. And you and you do want to ask some questions about smoking cessation and alcohol and, and and those types of things. But you all you need As a medically relevant history. So that may change how what what your forms look like. And ultimately, who asked them, you may not have to get forms up front, maybe you choose to have that done by your ma set things up in the office.

Or you actually still have that stuff coming through the portal, but you shorten those templates up so that you can get your patients moving through the practice a little bit faster. Talk to your clinical staff about what they're going to do about their new physical exam. They don't have to do the same level physical exam anymore, you can really go to a problem focused exam. So that could make things a little bit easier. But think so don't think just about your EHR, although that's the next point that you really do need to think about is how your EMR templates are going to be there are your is your EMR vendor going to update everything? Are they going to update the calculator and the forums or just the forums. You do want to know that you've got Some time for your champions to test it, and then some time to help train your staff. So check with your EHR vendor, but then go back and double check with your clinical staff and see what can you do to the office flow to make it better. Then, the next group you want to step in with is take a look at where the RV use are going to come out using the proposed rule and start looking at your proposed the financial impact of what's going to happen. This may not be something that you do right away, but it does, it is something that we recommend you look at for the beginning of the year. And part of this is going to require some knowledge as to, you know, are a number of your codes gonna move down from a four or a three are encounters, going to move down from a four to a three are some going to move up from a three to a four, and maybe some more fives based on the way that your practice functions. So those are things that you want to get in place. And then finally, incorporating into the compliance program where you have your review set and you're a little more aggressive training, you need to actually come back around and set up your schedules for your, you know, as, as all things work, train, test, retrained, retest, that program scheduled needs to be outlined as you're moving forward. So, that's kind of that setup that we're that we're that we're recommending that you start building those things, look towards those things. Join us in our training sessions coming up. And we'll address these with maybe a little more detail and assistance. And certainly when we get to the webinars, we're going to be doing some in depth dive on how to use these new guidelines to the to actually maximize the patient encounter and as always, medically appropriate. reporting of reimbursement for reimbursement.

Scott 14:03
Excellent. All right. So I think let me let me just recap the steps just in number, numerical format or just in order. Number one, pick a champion, you know, relief, really find somebody to place the monkey on their back and make sure that you have that champion, identified. Number two, update your compliance plan. Number three, make sure you get your team trained, identify who needs training, and get them trained. And as Mark mentioned, we do that that's one of the things that the e&m live trainings all about. So, you know, all this will cover all this but, you know, we can we can help you with that. We've, you know, identified how to get from point A to point e&m you know, so, so yes, we we've done that we understand that we can help you with that. Number four, update your processes. Again, we can help suggest I will suggest how to do that on the the live webinar, but you need to do that. Number five, your EHR. Make sure your templates are updated tested, you got your people trained. Number six, estimate the financial impact. And number seven schedule ongoing training and review. So those are the seven steps to the checklist.

Anything else to add to that?

Ray 15:30
Yes, I'd like to add a couple of things. Number one, to re emphasize. What Mark emphasized in the previous podcasts is that even though this is the interim our proposed rule, we're fairly comfortable that the rules we're looking at now for e&m are going to be the final rules you're going to be working with in 2021. The only caveat is there could be some minor Weeks which will be covered in a seminar in December. Number two is this is truly sort of Back to the Future. In other words back before the the current documentation guidelines, we took care of patients and our documentation was really what was medically necessary of what we did and what we documented. What a novel idea, medical necessity taking care of patients. And that's what we'll be doing with the documentation and the requirements in the future. With one caveat, they are having more detailed identification of your medical decision making. This is where you're really going to have to pay attention to the detail This is where mark is got laid out a number of scenarios to help you. And with the new Pocket Card and wall chart, I think that we can make this transition easy.

Mark 17:15
Great, good. Yeah. Well, we certainly look forward to having you join us if you can with the evaluation and management training and, and certainly, we'll be watching as Medicare and the various entities that pay bills, trying to adapt to all the new guidelines with new with new audit sheets and everything else. So keep keep keep trucking on and, and we look forward to seeing you again real soon.

Scott 17:53

All right. We will wrap this one up. And remember, we're we're here to help You out and please check out our webpage BRS network comm forge slash 018 for the 18th episode and you'll have all this information, the checklist and information on how to sign up for the webinars on on that page. So until next time, happy coding.

Thank you for listening to the urology coding and reimbursement podcast where we help urologist staff, keep economic practice efficiencies, time and energy to focus on.

Special thanks to Karl Painter for the music today. You can find his music under his record label but usually with extra code and special guests