Category: SHP News

Register for Your Seat at SHP’s QPP Final Rule Webinar

Register for Your Seat at SHP’s QPP Final Rule Webinar

Just under the wire! On Dec 1st, CMS just released the long-anticipated QPP 2021 Final Rule. This next Wednesday, Dec 9th @ 12PM EST, SHP is offering a free webinar to bring you up-to-speed on the latest changes to QPP (MIPS & APMs) that go into effect on Jan. 1st, 2021.

Register now to reserve your spot. Hurry, seats are limited!

Webinar Agenda:

  • Results from the 2019 Reporting Year
  • Exemptions, including COVID-19 & Hardship
  • Changes for MIPS
  • Changes for APMs
  • Q&A

Alert….Telehealth Coverage Updates

The COVID pandemic expanded telehealth coverage availability across almost all health plans (Commercial/Medicaid/Medicare) by eliminating originating site criteria and expanding codes covered in a telehealth setting. For the most part, we’re still in a holding pattern on current coverage guidance; based on either State or Federal Public Health Emergency declarations or plan coverage decisions through 12/31/2020. Below are the most recent policy updates/coverage decisions for Medicare/Medicaid/the major payors. For UHC and Anthem commercial plans, the cost-share waivers for telehealth have already ended but for the other carriers, they will remain in place through the end of this year. Obviously, we’re seeing an uptick in COVID now which could well extend these policies past the end of this year. From a more general perspective, we do believe that most payers will keep some telehealth accommodation going forward as the genie is out of the bottle at this point.

Medicare Telehealth

CMS will continue covering expanded telehealth services through the COVID-19 Public Health Emergency. On 10/23/2020, Secretary Azar expanded the PHE for another 75 days through January 2021. Based on current COVID uptick, there is every reason to believe it will be extended again in January. Traditional Medicare and Medicare Advantage plans should continue following the same expanded benefit for the duration of the PHE.

Medicaid Telehealth

Traditional Medicaid and the CMOs will maintain the expanded telehealth coverage through the end of the state Public Health Emergency declaration. The current PHE will run through December 9, 2020.


Telehealth expanded coverage remains in place. Through 12/31/2020, Aetna will continue waiving cost-share for in-network, telehealth medical services for commercial and Medicare plans. For commercial plans, self-insured business can opt-out of the waivers and still require patient cost-share. On September 30, 2020, telephonic only visits without video connection reverted to standard pricing mechanisms (from March through September, telephone only visits paid the same as standard telehealth visits).


Anthem’s cost-share waivers ended for commercial plans on 9/30/2020; however, the cost-share waiver will remain in effect through 12/31/2020 for Medicare Advantage plans.


Cigna’s enhanced telehealth rates will remain in place through December 31, 2020 and cost-share waiver through January 21, 2021. On their secure website, they have a new virtual care policy that will launch on January 21, 2020 which you should access for any updates.

  • In an effort to make it as easy as possible for our customers to access timely and safe care, while ensuring that providers can continue to deliver necessary services in safe settings, Cigna will allow providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19, through December 31, 2020.
  • This means that providers can perform services for commercial Cigna medical customers in a virtual setting and bill as though the services were performed face-to-face.
  • Providers should bill using a face-to-face code, append the GQ, GT or 95 modifier, and use the POS that would be typically billed if the service was delivered face to face (e.g., POS 11).
  • Providers will be reimbursed consistent with their typical face-to-face rates.
  • Providers can also bill code G2012 for a 5-10 minute phone conversation, and Cigna will waive cost-share for customers until January 21, 2021. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time.
  • Customer cost-share will be waived for COVID-19 related virtual services through January 21, 2021.
  • Please review the “Virtual care services” frequently asked questions section below for additional information about our interim COVID-19 virtual care guidelines.
  • Effective January 1, 2021, we will implement a new Virtual Care Reimbursement Policy. Please visit for additional information about that policy.


Humana’s cost-share waivers for telehealth visits will also expire on 12/31/2020. No additional changes have been announced regarding the expanded coverage for services.

United Healthcare

UHC’s coverage is now being further defined by plan type (i.e. Medicare vs commercial). The full link is For commercial plans, the cost-share waivers are still in effect for primary care but have ended for specialist providers; and the cost-share waivers for all providers will continue through 12/31/2020 for Medicare Advantage plans.

If you have any questions, please let us know.


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.

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:


  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.


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.

Capitol Watch: Legislative Day 35

Legislative Day 35
It’s been a busy week at the State Capitol with many twist and turns as we see the legislative session
and term make its way to the end. We’ve seen many bills placed on other bills and an attempt to get
them passed this year. We will be on high alert in the remaining days. Please watch for alerts as we
close out the session.

Happy 140th Birthday to St. Joseph’s!

During the last 140 years St. Joseph’s Hospital has grown from a ramshackle, 12-room building to the technologically advanced 330-bed medical center of today.

“On this day we recognize not only one of the oldest hospitals in the nation, but also how the Sisters of Mercy have been visionaries for healthcare and for the betterment of our community,” said Paul P. Hinchey, President & CEO of St. Joseph’s/Candler. “The astounding growth and history of St. Joseph’s Hospital mirrors the growth of Savannah and our region. We are proud to be an anchor of the community and to provide the latest medical treatments to her residents.”

Pictures of St. Joseph’s Hospital from 1876 and 2014 can be found here:

The Sisters of Mercy took over the Forest City Marine Hospital on June 30, 1875. They were almost immediately hit with the Yellow Fever epidemic and the need to find a bigger space, which they found at Taylor and Habersham Streets.

That was home for St. Joseph’s Hospital until Sr. Cornile Dulohery and the Board of Trustees made the historic decision to move to Savannah’s developing southside, where it opened in 1970. In 1997, St. Joseph’s entered into a joint operating agreement with Candler Hospital to create the St. Joseph’s/Candler Health System.

Tuesday, the St. Joseph’s/Candler family and the Sisters of Mercy will celebrate this momentous day. There will also be a Mass of Celebration in the Riley Chapel on St. Joseph’s Campus.

From the days of battling Yellow Fever, St. Joseph’s Hospital has grown into a technological wonder. It houses three centers of excellence: The Institute for Neurosciences, The Heart Hospital and The Institute for Advanced Bone & Joint Surgery.

During the past few years St. Joseph’s Hospital has housed some first-of-a-kind medical procedures. In 2007 the hospital was the first in the region to use the da Vinci robotic surgical system. In 2013, it was the site of the region’s first minimally invasive Transcatheter Aortic Valve Replacement.

This year the hospital will see the completion of a $15 million interior and exterior renovation.

A brief history of St. Joseph’s Hospital:

1875-1876 – Responding to the plight of sick seamen, the Sisters of Mercy are contracted to operate the Forest City Marine Hospital. Better facilities and more space soon prompted a move to Taylor and Habersham streets. The hospital was renamed St. Joseph’s Infirmary. 

1901 – The hospital expanded (the Annex); the name became St. Joseph’s Hospital. 

1913 – The Flannery Memorial Wing opened.

1950s – St. John’s Hall (the city’s first psychiatric unit) and an obstetrical clinic for families with limited incomes opened. 

1960-1970 – The Sisters of Mercy moved the hospital from its downtown location to the city’s spacious southside, an area with high growth potential. The seven-story structure, situated on 28 acres, was dedicated on August 15, 1970. 

1981 – St. Joseph’s opened the city’s first Ambulatory Care Center. 

1986 – Hospital surgeons won the right to perform open heart surgery at St. Joseph’s. 

1997 – St. Joseph’s Hospital entered into a joint operating agreement with Candler Hospital and together formed St. Joseph’s/Candler, the region’s largest and most experienced health care provider.

2007 – Became the first in the region to operate using the da Vinci robotic surgical system. 

2008 – Opened a technologically advanced 13,000 square foot Neuro Intensive Care Unit. 

2013 – Became the first in the region to perform the minimally invasive Transcatheter Aortic Valve Replacement.

2015 – Completed a $15 million interior and exterior renovation.


Source URL Savannah CEO

Georgia’s “Hub and Spoke” model for rural healthcare providers

Rural hospitals in Georgia have received a much needed boost through the newly passed funding for the hub and spoke model.  There will be four hospitals designated as hubs statewide in this pilot project: Union General, Appling Health System, Crisp Regional and Emanuel Regional Medical Center.  The program has allocated $3m to help fund necessary infrastructure.  Under this mode, larger systems will direct patients to facilities suitable to provide the appropriate care, to help offset smaller rural hospitals from having to offer specialized services, where they lack the funding to sustain such care.

Georgia’s Hub-and-Spoke Model

Congratulations Norma Jean Morgan

Norma Jean Morgan Receives ACHCA’s Eli Pick Facility Leadership Award

Alexandria, VA — May 7, 2015 – The American College of Health Care Administrators (ACHCA) is proud to honor Norma Morgan, CNHA, FACHCA, Administrator of EFFINGHAM CO EXTENDED CARE FAC in Springfield, GA as a 2015 recipient of the ACHCA Eli Pick Facility Leadership Award. The award, named in memory of visionary ACHCA member Eli Pick recognizes administrators whose teams have achieved dimensions of organizational quality that few others have been able to reach. Two hundred and fifty seven administrators were awarded leadership awards nationally.

Mrs. Morgan was one of 227 receipts who received the Eli Pick Facility Leadership Award with virtual recognition. This award recognizes the administrator of record who provided leadership throughout the award year. Eligibility for this award is based on three years of skilled nursing facility (SNF) survey data, including the Health, Fire (Life Safety), and Complaint Surveys, as well as top quartile performance on designated Quality Measures. The criteria also included an 80% or greater facility occupancy and a three year avoidance of a Special Focus Facility status.

“Advancing leadership excellence is at the core of our mission,” commented Marianna Grachek, President and Chief Executive Officer of ACHCA. “There is a close relationship between facility leadership and quality outcomes-and, ultimately, between quality care and operational success.”

The ACHCA firmly believes that long-term care facility excellence is a reflection of leadership excellence. The prestigious Eli Pick Facility Leadership Award is made possible with the support of eHealth Data Solutions.

Founded in 1962, the American College of Health Care Administrators (ACHCA) is the only professional association devoted solely to meeting the professional needs of today’s post-acute and aging services leaders. Focused on advancing leadership excellence, ACHCA provides professional education and certification to administrators from across the spectrum of long term care. For more information about ACHCA, contact the national office at (202) 536-5120 or visit

Effingham Health

Doctors complain they will be paid less by health exchange plans

Article reposted from NBC News:

Written by:  Roni Caryn Rabin, Kaiser Health News

Many doctors are disturbed they will be paid less — often a lot less — to care for the millions of patients projected to buy coverage through the health law’s new Health Exchange marketplaces.

Some have complained to medical associations, including those in New York, California, Connecticut, Texas and Georgia, saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, potentially making it harder for consumers to get the care they need.

“As it is, there is a shortage of primary care physicians in the country, and they don’t have enough time to see all the patients who are calling them,” said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington D.C.

If providers are paid less, “are [enrollees] going to have difficulty getting physicians to accept them as patients?”

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors.

But many primary care doctors say they barely have time to take care of the patients they have now.

The conflict sheds light on the often murky world of insurance contracts in which physicians don’t always know which plans they’re listed in or how much they’re being paid to treat patients in a particular plan. As a result, some doctors are just learning about the lower pay rates in some plans sold in the online markets, or exchanges

“If you’re a physician and you’ve negotiated a rate from insurance, shouldn’t it be the same on or off the exchange?” said Matthew Katz, executive vice president of the Connecticut State Medical Society. “You’re providing the same service.”

Blues: No desire ‘to gouge’ docs A senior executive at Blue Cross Blue Shield Association said some of its 37 member organizations – each of which operate independently and offer a variety of plans – are offering lower rates to physicians in smaller exchange plan networks.

But, she said, plans know that a good network of providers is essential or customers “will go someplace else,” and they are enlisting sufficient numbers of doctors.

“We’re not motivated to gouge the doctor,” said Kim Holland, Blue Cross Blue Shield Association executive director for state affairs. “We depend on good relationships with quality physicians. … I can’t imagine any product we offer is going to have a physician rate that would discourage them from seeing a patient.”

But some physicians see things differently. Contracts between insurers and doctors vary with some allowing insurers to adjust rates unilaterally or to assign a doctor to multiple plans.

“I’ve participated with Oxford since 1985. They don’t send me a contract every year to sign. They don’t send me the rates. You don’t know the rates,” said Dr. Paul Orloff, a physician who is president of the New York County Medical Society. “It’s the only game in town so you sign. They have a right to unilaterally change the rates at any time during the contract.”

The benchmark for physician fees is the rate the federal government sets for services provided to older Americans through Medicare. In many markets, commercial plans may pay slightly above the Medicare rates, while doctors say that many of the new exchange plans are offering rates below that.

Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.

Some experts minimized the impact of lower pay rates on enrollees.

People “may experience wait times to get in, but that is not unique to people in exchange plans,” said Sara Rosenbaum, a professor of health law and policy at George Washington University,

Rosenbaum said she was not overly concerned about physicians’ compensation. “I don’t mean to suggest that physicians don’t deserve to do well,” she said. “But physicians are very well-compensated people, no matter what.”

Confusion about rates, provider lists Many doctors say they have not decided if they will participate in the new plans – in some cases, even when an insurer is including them in their provider list.

A survey by The Medical Society of the State of New York found that 40 percent of more than 400 physicians who had responded so far said they chose not to participate in a health insurer’s exchange plan, and one-third said they did not know whether they were participating or not.

“I have patients calling my office and saying … ‘Oh good, I see you’re in the network,’” said Patricia McLaughlin, an ophthalmologist in New York City. But, she added, “I’m not sure I am or am not at this point.”

Some insurers have contractual arrangements with physicians that allow them to automatically include doctors in a new plan, unless the physician requests to opt out in writing, according to Mike Scribner, CEO of Strategic Healthcare Partners, a health care consulting firm based in Savannah, Ga., that represents about 700 physicians and 30 managed care hospitals in the state.

Dr. Richard E. Thorp, an internist who is president of the California Medical Association and heads a physician-owned multi-specialty primary care group in Paradise, Calif., said one plan sold on that exchange “was going to pay us significantly less for doing that business. And we are already very busy.”

His practice delayed signing a contract, he said. But about three weeks ago, the group was informed the insurer was short on physicians and was therefore including doctors from other plans at their old rates.  So his practice was included at the higher rate.

Advocates say that consumers should be wary of information in plan directories and confirm participation with their doctors.

The California Medical Association is so concerned about errors that it has asked Covered California, the state’s insurance marketplace, to remove a search function that lets buyers plug in the names of physicians and get a list of all the plans that they participate in, said Lisa Folberg, vice president for medical and regulatory policy for the California Medical Association.

“There shouldn’t be any ambiguity about who’s in the network,” said Lynn Quincy, a senior analyst with Consumers Union, the policy division of Consumer Reports.

“These consumers are buying a product, one dimension of which is to provide a network–a very important dimension.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.