Original Medicare E/M requirement

Clarification of E/M service documenting requirements

At the beginning of 2019, the Centers for Medicare & Medicaid Services (CMS) outlined changes in how providers should document evaluation and management (E/M) services for Original Medicare. Some providers have asked us if Humana is adopting those changes. We are not. CMS has not indicated that those changes apply to Medicare Advantage plans.

Key points:

  • For 2019, CMS outlined Original Medicare changes to E/M documentation that will allow practitioners to avoid repetitious entries in the medical record.
  • The changes address documentation of procedural elements that previously were required for various levels of E/M coding and claims payment.
  • The rule does not impact CMS’ Part C Medicare Advantage guidance requiring accurate and complete documentation, to the highest degree of specificity, for all conditions coexisting at the time of the encounter and requiring or affecting patient care management or treatment.
  • For services provided to Medicare Advantage enrollees, practitioners should continue to document the relevant clinical information that supports every condition for all encounters.