Medicare Impact of proposed E&M Guideline changes

The CMS proposed 2019 E&M changes compress the current five levels of service for new and office visits into two levels. They have also created RVU values for those two services. As such, every practice is going to have some financial and RVU impact as a result of these changes. Practices that tend to code from the middle level down will likely see increase in payment while those that tend to code from the middle level up will see a decrease in payment.
To see how the new changes will impact your providers, enter their NPI code in the field below. To assess the impact, we use the difference between the 2018 and 2019 RVU values and use your Medicare frequency for the office visit procedures based on the 2016 Medicare database. The results are an estimate of what the impact would have had on your provider had this model been in effect in 2016.


Year:    NPI to research: 

Interpretation Guide

For each procedure code, there are five columns:
  1. Total RVU Delta – This takes the difference between the 2018 work + practice expense RVUs and the 2019 proposed RVU. Here, we subtract 2018 from 2019.
  2. Financial Delta – This column involves several calculations. First, we multiple the count times the total RVU for both 2018 and 2019. Then, we multiply the respective total RVU values times the respective conversion factors. The next step is to subtract the 2018 allowed from the 2019 allowed. This gives us the best estimate for the financial difference.
  3. Financial Impact – Here, we divide the financial delta by the 2018 allowed amount based on the counts you report in the Total Count field. The purpose here is to calculate what the percent change will be moving from 2018 to the proposed 2019 model.
  4. Work RVU Delta – This is simply the difference between the 2018 actual work RVU and our derived 2019 work RVU times the Total Count.
  5. Work RVU Impact – For this column, we take the Work RVU Delta an divide it by our calculated total work RVU for 2018 based on the values in the Total Count column.