Hi All,

I would like to give you all some important information from the AAFP Winter Cluster meeting today. There are three important items.

First, the newest proposal of CMMS for collapsing billing codes and decreasing documentation requirements are below and are slated to go into effect in 2021.

1) All level 2-4 visits will be paid the same amount (approx. $135). New and established visits get paid the same.

2) There will be add-on codes for “Primary Care services” for each visit ($13)

*It is expected that every visit will have this code added.

3) There is a code for “Extended time” meaning an extra 30 minutes over the time for a 99214 visit ($67).

*The time spent after the visit (calling referrals, getting prior authorizations, etc.) counts towards the 30 minutes.

4) Billing will be done based on “Decision making alone” or “Total time spent”, not on how much history or exam is documented.

Second, the documentation decreases below are currently in place.

In addition to the current rules where ancillary staff can document ROS, and Past Medical History, ancillary staff can document History of Present Illness and Chief Complaint as well.

*The doctor has to state that the info was reviewed in their documentation.

Third, this year, for the first time since 2006, the RUC will be reviewing and re-valuing the E&M codes (99201-99205 and 99211-99215). This is a big deal for us!

As the basis of their efforts, they will be using a survey of doctors which will be asking them information about their practices and the costs associated with providing patient care. The AAFP will be sending emails in the next month to ask all members to complete the survey. Some issues you need to know about:

1) The survey will ask lots of complex information about your practice. You will likely need to get your office managers to help get the information.

2) You should have ALL of the partners in your office fill out the survey even if it is the same information.

*The changes to the ABFM process was successful in large part due to the massive response of family doctors expressing their discontent with the ABFM to the Visions committee on their survey. There are more of us than ANYONE! We can effect change if we make our voice heard.

3) We need to get the RUC to appropriately value our services now since the next generation of pay-for-performance/population health incentive payments will be based on this round of RUC valuations.

The AAFP and AMA will be posting instructions including You Tube videos to help us with the details of filling out the survey. I will try to send information to everyone through the NDAFP email list and Facebook posts as more information becomes available.

Let me know if you have any questions.

Jeff Hostetter

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Jeff Hostetter, MD, MS, FAAFP
Program Director

UND Center for Family Medicine
jeffrey.hostetter@und.edu