Code Encounters

Healthcare organizations that achieve Joint Commission accreditation meet or surpass CMS’s standards for acceptance into the Medicare and Medicaid programs. To keep accreditation in good standing being permanently prepared for “surprise inspections” is integral as requirements change.

As many RHC providers can attest, it feels like they are the ugly stepchildren of CMS at times. Many Medicare benefits were not payable in the past to an RHC provider. CMS has implemented some needed changes effective January 1, 2022

2021 CPT E/M Guideline Definitions for Acute and Chronic Illnesses

Acute, uncomplicated illness or injury

Elements

In the past both history and exam have been required for code selection. With the new changes both history and exam will need to be documented but will not affect the code selection. There will be no minimum requirement, beyond establishing medical necessity and the standard of care. Providers will be able to select the E/M service level either by the level of medical decision making or by the total time spent performing the service on the day of the encounter.

Per CMS: they have “established an internal process to evaluate and streamline regulations with a goal to reduce unnecessary burden, to increase efficiencies, and to improve the beneficiary experience. In carrying out this internal process CMS is moving the needle and removing regulatory obstacles that get in the way of providers spending time with patients.”