NGS Changes E/M requirements for Expanded Problem Focused and Detailed Examinations


On March 16, 2017 National Government Services (NGS), a Medicare Administrative contractor (MAC), announced changes to documentation requirements for expanded problem focused and detailed examination. These changes, based on the 1995 documentation Guidelines, will make it more challenging to achieve higher levels of service for providers in in this MAC. 

Under the new updates the definition of expanded problem focused and detailed exam has been updated to include more body areas/ organs systems. An “expanded problem focused” exam will be defined as 2-5 body areas or organ systems. A “detailed” exam has been changed to include 6-7 body areas or organ systems. Per NGS, the changes were made in response to provider requests for clarification on the current examination requirements.

NGS currently administers the Medicare Part A (hospital insurance) and Part B (medical insurance) contracts for the following states: Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Wisconsin. For medical service providers in these states, the changes will be effective on July 1, 2017.