*Update: The 2021 OMFS updates drastically changed how E/M codes are billed.*

Some of the most commonly used billing codes by our providers, Evaluation and Management (E/M) codes are still being paid at 2017 rates for 2018 dates of service. While the difference for each code may be a matter of a few percentage points, all those extra dollars and cents add up! Providers, review your bills to make sure your office is being reimbursed in full.

The 2018 OMFS updates were mostly modestly good news for providers, with small increases for almost every one of the most popular billing codes. But over the last several weeks, we’ve noticed a troubling trend of outdated payor systems resulting in outdated payments for services rendered since January 1.

While we discussed the unfortunate trend last week, we thought it worth shining a particularly strong light on reimbursements for day-to-day office visits, often the bread and butter service for many providers. For example, reimbursement for Current Procedural Terminology (CPT) Code 99214 for established patient visits is higher by almost 2% in 2018. And yet, here’s one example of a recent underpaid bill:

Similar incorrect payments for other E/M billing codes, including CPT 99204 for new patient office visits, have surfaced too often since January. This necessitates second reviews that cost providers (and claims administrators) precious time.

While finding and addressing these errors is much easier for providers using effective dedicated work comp billing software, other providers are bound to lose money via the steady trickle of out-of-date reimbursements.

For a full list of updated E/M reimbursements rates, see our 2018 Evaluation and Management Cheat Sheet. For other oft-used procedure codes, including those for surgery, radiology, and medical-legal services, see our Ultimate 2018 Cheat Sheet.

As always, if your office is underpaid for any reason — including the failure of the claims administrator to update their payment systems — be sure to submit a compliant request for second review within the mandated 90-day deadline. By holding everyone on both sides of the billing and payment equation accountable, we can make workers’ comp work better for all.

With DaisyBill, identifying and correcting payor errors is fast and easy. Our billing software automatically compares payments received to OMFS rates, and generating requests for second reviews is a snap. Sign up for a free demonstration, and see how much better work comp billing can be.

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