Insider Info: Making the Most of E/M Revenue

Primary Care Practices have been under financial strains for years, and the Covid-19 pandemic has not made things easier. A recent survey of primary care practices by the Medical Group Management Association showed that 97% of the respondents saw a negative financial effect from the pandemic. 

Most of the financial impact is from patients postponing diagnostic visits for issues like heart disease, cancer, and diabetes, which could have severe impacts for patients. In fact, a July 2020 survey of healthcare leaders showed that 87% of patients cited “safety” from COVID-19 as the primary reason they deferred seeking medical care. 

So, what can primary practices do? Partnering with a complementary provider like New Frontier to add in-office diagnostic imaging can help a practice increase patient E/M revenue, and encourage a safe, comfortable environment for patients to receive the health services they need. 

Billing Pro Tip: Little Changes Equal Big Results

An analysis of data provided by the Centers for Medicare and Medicaid Services (CMS), shows that the Evaluation and Management procedure codes 99201-99215 account for 40% of all reported CPT codes, and 20% of revenue for primary care practices. In other words, E/M revenue is the critical base  that supports primary care practices. 

The pandemic demonstrated that changes in the volume of patient traffic can make a significant impact on these numbers, but practices can counteract that impact by increasing their average revenue per patient. The easiest way to do that is through offering more complex, data-supported medical services with a partner like New Frontier

Example: a patient presenting with an issue that previously only took 15 minutes of the physician’s time could be coded under 99213, with a CMS allowable rate of $76.15. With a more complex issue justifying more time and supported with appropriate documentation, the practice could use 99214, with a CMS allowable rate of $110.43, a 45% increase in revenue for that patient visit. 

2021 E/M Coding Changes: It’s All About Time

In the 2020 Physician Final Rule, CMS introduced some major changes to E/M codes coming in 2021. The primary highlights are:

  • The changes only effect office and other outpatient codes, specifically 99201-99215
  • New patient level 1 code 99201 will be deleted
  • Level of service will be determined based on medical decision-making and/or time

While these changes have shifted much of the focus to the time spent in medical decision making, the time spent with the patient must still be supported with a thorough history and appropriately documented. Auditors look for real-time documentation of what the physician is thinking and how concepts like acuity and risk are being integrated into the status decision. 

More than ever, the documentation supporting the time spent with the patient must be both medically necessary and informative. Timely, informative imaging reports provided by qualified interpreting physicians are an example of the documentation needed and are part of engaging a partner like New Frontier. 

The New Generation of Care

While patient visits are down, the incidence of medical issues affecting patients did not take a break during the pandemic. 

Patients still need to have conditions diagnosed and treated, but fear of exposure to COVID-19 has caused patients to wait on critical care. A September 2020 report from the CDC showed an estimated 40.9% of U.S. adults have avoided medical care during the pandemic because of concerns about COVID-19, including 12.0% who avoided urgent or emergency care and 31.5% who avoided routine care.

Practices across the country implemented protocols to defend against the pandemic, but often those adjustments only addressed services already offered within those practices. Telehealth spread quickly to deliver current services to patients, but not all conditions can be diagnosed or treated remotely. 

If a condition requires a referral to another provider, the practice loses control over the patient’s experience and patient concerns grow. This puts physicians in a challenging position – do they expose patients to additional risk by sending them to another facility, or do they forgo critical diagnostic information?

Fortunately, telehealth was just the start of options for practices to adjust to the pandemic, and advancements in technology make it possible to bring a number of new services into the practice. 

One example that can make a major impact for a practice is the addition of a portable diagnostic imaging provider, using tools like ultrasound or x-ray imaging devices to gain the following benefits for patients:

  1. Care/Compliance with Treatment Plan – Patients prefer having procedures performed in a comfortable, familiar environment, increasing the likelihood they will seek help and comply with additional care instructions. 
  2. Convenience for Practice Staff – Having an integrated partner with consistent processes makes it easier for staff to request diagnostic procedures and know when and how study results will be provided. 
  3. Control over the Patient Experience – Practices that control and enhance the patient experience with additional services while alleviating inconvenience and fears of COVID are more likely to maintain those patients throughout the continuum of care.
  4. Cost and Capitation Bonuses – In-office services avoid the additional costs of overhead from a hospital or imaging center, dramatically cutting the cost of care for your patients. This not only saves patients money; it could also benefit any capitation plan bonuses to the practice. 

By providing additional services in the controlled, familiar environment of the office with a trusted partner, practices can increase revenues and improve patient relationships.

Growth Through Partnership

Prior to the pandemic, physicians that decided to integrate diagnostic imaging into their practices often found that the costs made it difficult to justify a full-time resource. When factoring the cost of equipment, imaging software, interpreting physicians, and the salary and training of the technologist, the costs of implementing an in-practice solution quickly can easily add $200,000 in costs, making it prohibitive for most practices. That is where a partnership with New Frontier comes in. 

New Frontier Mobile Diagnostics specializes in portable diagnostic imaging for the diagnosis of Cardiac, Vascular, and General Abdominal conditions. 

New Frontier has made the investment to bring ARDMS certified, experienced technologists into physicians’ offices, where the techs use high-quality diagnostic imaging tools like GE Vivid Ultrasounds to produce studies, which are then interpreted by qualified, local physicians from Healient Physician Group. 

We provide the documentation and support necessary to improve medical decision making while the patient is still engaged in the practice. This presents several benefits for the practice:

  1. Imaging reports to support E/M coding complexity, document increased time
  2. Faster access to diagnostic information (most reports returned within 1-2 business days)
  3. More control over the patient experience, more compliance

In essence, New Frontier can provide a fractional imaging department built within a primary care practice, offering patients access to quality diagnostic care while improving per patient revenues for the practice. 

While the pandemic forced some rapid changes in healthcare, many of these changes were a long time in coming. Practices must adapt to the ever-changing environment by partnering with companies like New Frontier, helping find new ways to improve per patient revenues while improving the quality of care and patient experience. 

Call New Frontier today at 913.428.9488 or email info@NewFrontierMD.com to see if adding in-office diagnostic imaging can serve your patients’ needs and increase your practice’s revenue.