Revisiting E&M Visit Guidelines — A Missing Piece of Payment Reform

Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout

“…There are five levels of payment, which are determined by a tabular interplay of four levels of medical history, four levels of physical examination, and four levels of medical decision making [12]. This results in abundantly detailed documentation, which is necessary for billing purposes, and, with the exception of medical decision making, is often clinically irrelevant [13]. The EHR compounds this problem by facilitating the collection of many redundant or irrelevant details.…”

Developing Codes to Capture Post-Operative Care

“…Use of an existing flawed system. The E&M system is felt to be a generally flawed way to capture visit complexity (Berenson, Basch, and Sussex, 2011;Berenson and Goodson, 2016;Brett 1998). As one critic argued,…”

“…This has led to numerous problems, including overdocumentation, upcoding, and undercoding (Berenson, Basch, and Sussex, 2011).…”

Including Physicians in Bundled Hospital Care Payments

“…However, physician notes are bloated with excess documentation to satisfy complicated billing guidelines so that current documentation guidelines may hinder effective communication. 6 There have been concerns that the efficiency and quality benefits of electronic health records have been Including physicians in the DRG payment could lead to better physician engagement in quality improvement efforts and, therefore, improved success of those efforts.…”