News You Can Use

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!

Updated Evaluation & Management Services Guidelines

Updated Evaluation & Management Services Guidelines

The AMA just released additional technical revisions to E&M coding; which were overhauled on January 1, 2021 to hopefully simplify documentation and coding requirements for codes 99202-99215. We’re therefore pleased to share the latest guide that we have generated regarding the new documentation standards. As health plans continue to aggressively audit services; we do think it will be worthwhile to internally audit your E&M documentation in accordance with the new standards as these vary so greatly against previous documentation requirements. If you have any questions or concerns regarding the new standards, please let us know. Thank you.

Download the E&M Services Guidelines here.

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

News You Can Use – January 2021

News You Can Use – January 2021

  1. Congress Passes New and Additional Support For Health Care Providers, Patients, COVID-19 Mitigation and Vaccination Link
  2. Hospital Price Transparency – Appeals court ruling paves way for price transparency rule to go into effect on January 1, 2021. Link
  3. CMS Final Rule: CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Link
  4. CMS Announces New Model to Advance Regional Value-Based Care in Medicare Link
  5. Trump Administration Finalizes Permanent Expansion of Medicare Telehealth Services and Improved Payment for Time Doctors Spend with Patients. Link
  6. Application Deadline for CHART Model Extended Link

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
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.

Aetna

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

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.

https://providernews.anthem.com/georgia/article/information-from-anthem-for-care-providers-about-covid-19-4

Cigna

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 CignaforHCP.com/virtualcare for additional information about that policy.

Humana

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 https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-telehealth.html. 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.

Thanks!

SHP Lunch ‘n’ Learn – QPP 2021 Final Rule

SHP Lunch ‘n’ Learn – QPP 2021 Final Rule

Every year, CMS updates and revises the Quality Payment Program for MIPS & APMs. This year is no different, despite the on-going pandemic. In the summer, CMS released a Proposed Rule that would further evolve the program for the next reporting year. CMS will release the QPP Final Rule in December, just under the wire for adjusting your 2021 QPP Plan.

How will these changes impact Reporting Year 2021? Find out by registering for our free QPP 2021 Final Rule webinar on Dec 9th at 12:00pm EST.