Category: COVID19

SAMGMA May Meeting – Market Update by SHP

SAMGMA May Meeting – Market Update by SHP

We would like to thank the Savannah Area Medical Group Management Association for inviting us to their monthly luncheon this week. A great group of engaged Administrators from the area, representing a dynamic and diverse set of providers.

This discussion included updates regarding COVID activity such as the HHS Provider Relief Fund and Medicare prepayment recoupments, Regulatory Activity, and Payer Activity in their market. A look at events that has impacted you, or soon will be, regardless of setting, size or specialty. An external view of the market always make for productive conversation.

Thank you again to Allison Griffin and Trish Rotureau for spearheading the group and the opportunity.

Click here to download the meeting’s PowerPoint.

Upcoming Spring Webinars – Georgia Legislative Session Recap & Surprise Billing Legislation

Upcoming Spring Webinars – Georgia Legislative Session Recap & Surprise Billing Legislation

SHP is excited to announce two upcoming webinars this Spring. These timely webinars will delve into the most recent healthcare changes from the 2021 legislative session as well as how to understand the rules issued by the DOI for Surprise Billing. Join these free webinars with the links below. We will also post recordings and material in our webinar archive after the session.

Wednesday, April 14, 2021 at 12:00 noon: Georgia Legislative Session Recap

Please join SHP’s Legislative Affairs Team for a recap of key legislation from the 2021 session and to understand what bills will impact you in the coming year! A mini COVID update will be provided with the latest news from HHS and the American Rescue Plan. Use this link to join us at 12:00pm Eastern on Wed. April 14th!

Wednesday, May 5, 2021 at 12:00 noon: Georgia’s Surprise Billing Legislation

SHP will be joined by Michele Madison pf Morris, Manning & Martin to discuss the enactment of Georgia HB 888 for Surprise Billing by healthcare providers. HB 888 took effect on 1/1/2021 utilizing a set of operational rules and regulations developed by the Department of Insurance (DOI). Join us at this link to learn about the impact that this will have on your operations on Wed. May 5th!

Register for SHP’s American Rescue Act Webinar

Register for SHP’s American Rescue Act Webinar

Following the passage of the American Rescue Act; the fourth stimulus package tied to the ongoing COVID crisis, we’re pleased to announce an upcoming webinar that will detail the key healthcare and employer/business provisions included in the legislation. Please join us on Thursday, March 18, 2021 from 12:00-12:45 p.m. to learn more.

For the best experience, please join us via the link below:

https://www.gotomeet.me/Strategic-Healthcare/the-american-rescue-plan

COVID Update – January 2021

  1. HHS Funding Link
    1. Recipients of Payments more than $10,000 in the aggregate under the following distributions.
      1. General Distributions
        1. Phase #1-Medicare
        2. Phase #2-Net Patient Revenue
        3. Phase #3-Equality for Net Patient Revenue across more provider types plus additional allocation (undefined at this point) based on lost revenue
      2. Targeted Distributions
        1. Safety Net Hospital
        2. Rural Hospital & Rural Health Clinic
        3. COVID High Impact Rounds 1 & 2
        4. Medicaid Distribution
    2. Reminder- Original terms and conditions: Recipients agree that funds will only be used to prevent, prepare for, and respond to COVID and shall reimburse recipient only for health care-related expenses or lost revenues attributable to coronavirus.
  2. HRSA – COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration. OverviewFAQ
    1. Telehealth Updates
      1. CMS
        1. Official guidance on diagnoses from telehealth services for risk adjustment: What you need to know Link
        2. Telemedicine Health Care Provider Fact Sheet Link
        3. List of services payable under the MPFS when furnished via telehealth Link
      2. HHS – Telehealth Guide to Delivering Care Safely During COVID-19 Link

HHS Funding – Who is Required to Report?

  1. Recipients of Payments more than $10,000 in the aggregate under the following distributions:
  2. General Distributions:
    1. Phase #1-Medicare
    2. Phase #2-Net Patient Revenue
    3. Phase #3-Equality for Net Patient Revenue across more provider types plus additional allocation (undefined at this point) based on lost revenue
  3. Targeted Distributions:
    1. Safety Net Hospital
    2. Rural Hospital & Rural Health Clinic
    3. COVID High Impact Rounds 1 & 2
    4. Medicaid Distribution
  4. Reminder- Original terms and conditions: Recipients agree that funds will only be used to prevent, prepare for, and respond to Covid and shall reimburse recipient only for health care-related expenses or lost revenues attributable to coronavirus.
  5. Are any HHS/HRSA Funds Excluded from this Reporting? Yes! These final reporting requirements do not apply to:
    1. Nursing Home Infection Control distribution recipients
    2. Rural Health Clinic Testing distribution recipients
    3. Health Resources and Services Administration (HRSA) Uninsured Program reimbursement recipients

SHP Fall Webinar Series New Dates

SHP has added new dates and topics in our Fall webinar series, which focuses on a variety of current and bottom line-impactful  topics.

These webinars serve as a tool to educate and provide actionable takeaways for healthcare providers on real time COVID updates, QPP 2021 Rules, and Revenue Cycle best practices such as Managed Care and Provider Enrollment.  We are also pleased to have the Commissioners for both the Department of Insurance (DOI) and Department of Community Health (DCH).  So, please order in lunch as we interactively discuss such topics amongst your peers.

Visit our webinar schedule for updated information.

HHS Round 3 Portal Application

Department of Health and Human Services (DHHS) has announced another round of General Provider Relief.  The $20B allocation is intended to ensure all providers achieve a relief payment if at least 2% of their net patient revenue and remaining funds will be allocated as a Phase 3 distribution.  The application cycle is open from October 5 to November 6 and funds will be allocated on a first-come/first-serve basis so please join us to walk through the application process.

https://www.gotomeet.me/Strategic-Healthcare/shp-fall-series-hhs-round-3-portal-application

HHS Provider Relief Phase 3

Health & Human Services has now announced a third cycle for General Provider Relief Funding and have queued up another $20B distribution. Under this new cycle, previously ineligible providers, such as those who began practicing in 2020 will be eligible to apply, as well as an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.

This application cycle is open to all providers eligible for a previous PRF distribution, plus new 2020 providers and behavioral health providers may apply. Providers are eligible regardless of whether you were eligible for, applied for, received, accepted, or rejected payment from prior PRF distributions. The new portal opened on October 5, 2020 and will be a first-come; first-serve distribution.

Please see attached guide that walks through the application process.

SHP Fall Webinar Series

SHP, in collaboration with various partners and legislative representatives, presents our Fall webinar series, which focuses on a variety of current and bottom line-impactful  topics.

These webinars serve as a tool to educate and provide actionable takeaways for healthcare providers on real time COVID updates, QPP 2021 Rules, and Revenue Cycle best practices such as Managed Care and Provider Enrollment.  We are also pleased to have the Commissioners for both the Department of Insurance (DOI) and Department of Community Health (DCH).  So, please order in lunch as we interactively discuss such topics amongst your peers.

Visit our webinar schedule for more information.

Quality Measures & Telehealth

Just before the 4th of July holiday weekend, CMS released new guidance for which eCQMs can be used during a telehealth visit for Reporting Year 2020. This unexpected update was the result of questions regarding if home-captured data was “good enough” for Quality Measures. Fortunately, out of the 47 eCQMs that exist, a total of 42 are telehealth allowable. As with everything, there is a caveat: some measures may require an in-person element that cannot be achieved fully with just telehealth. So while an eCQM is eligible, there may be an extra step required to complete the measure.

Measure Highlights

While the complete list available here, we do want to highlight the ones that we find most commonly used by practices:

Allowed:

  1. 50v8 – Receipt of Specialist Report
  2. 68v9 – Documentation of Current Medications
  3. 122v8 – Diabetes Hemoglobin A1c Poor Control
  4. 128v8 – Anti-depressant Medication Management
  5. 135v8 – Heart Failure Medication Therapy (ACE inhibitor or ARB or ARNI therapy)
  6. 138v8 – Tobacco Screening & Cessation
  7. 139v8 – Falls Screening
  8. 156v8 – Use of High-Risk Medication in the Elderly (inverse measure)
  9. 159v8 – Depression Remission at 12 months
  10. 161v8 – MDD Suicide Risk Assessment
  11. 165v8 – Controlling High Blood Pressure
  12. 347v3 – Statin Therapy for Treatment of CVD

NOT Allowed:

  1. 22v8 – Screening for High Blood Pressure & Follow-up
  2. 69v8 – BMI Screening & Follow-up
  3. 157v8 – Medication & Radiation Paint Intensity Quantified
  4. 129v9 – Prostate Cancer Overuse of Bone Scan
  5. 133v8 – Cataracts 20/40 or Better Within 90-days Following Surgery

What About MIPS CQMs?

eCQMs that have a MIPS CQM equivalent (formerly called Registry Measures) are also telehealth eligible/ineligible! Remember, the difference between the measure sets is: targeted population and (usually minor) differences in their formulas. Generally, however, the MIPS CQMs are identical in nature to their matched eCQMs.

If you have a MIPS CQM (there are 196 of them) you can safely assume it is NOT telehealth eligible if it is not on the list. If you are relying on telehealth visits and have MIPS CQMs not on the list, you will need to adjust your measures.

What About Specialty Registry Measures?

The guidance released only applies to measures that CMS oversees: MIPS CQMs & eCQMs. The onus is on the Qualified Registry to determine if a telehealth visit and their data standards are an equitable match. If you have a specialty registry, that you are using to report MIPS Quality, be sure to consult with them about this.

Going Forward

CMS has said that this list of CQMs for 2020 is final. However, they did also release a list for 2021 which has FEWER (39) measures allowed. Fortunately, those three extra measures are not common. It is important to note that this list is not final and may change between now and Jan 1, 2021.

As the 2021 list is updated we will provide you our analysis if anything significant changes. At this point, however, we do not believe that it will change radically.

Conclusion

The rush to telehealth brought about questions that almost no one was asking: “What Quality Measures can be done outside the clinic?” CMS has responded with a well-crafted list of measures.

As always, CMS reserves the right to change the MIPS program to adapt to the health community’s needs. Though it appears that they are finished changing the program for 2020. Historically, in late July, CMS releases a Proposed Rule that becomes final in late-Oct/early-Nov. Therefore, SHP anticipates additional changes to the MIPS program for 2021, but no further major changes to the program for 2020.

Practices, particularly those who are relying on Telehealth, should re-evaluate their Quality Measures against this list. If you find that you were using a measure that is not eligible, you may want to consider requesting an Extreme & Controllable Circumstances Exception for the Quality Category.

If you are not sure if you should file an ECCE, or if you want assistance with picking your eCQMs, contact your SHP Representative and they will get you in touch with our MIPS expert.