Committees/Workgroups

Careers

BILLING, CODING AND PAYMENT

August 4, 2020

Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87426
CMS issued a new MLN Matters Article MM11927 on Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87426 (PDF). Learn about this QW modifier for Infectious agent antigen detection by immunoassay technique by clinical laboratories.  Read More

May 20, 2020

Medicare Payment for COVID-19 Diagnostic Tests

Earlier this year, CMS took action to ensure America’s patients, health care facilities, and clinical laboratories were prepared to respond to COVID-19. To help increase testing, CMS developed two codes that laboratories can use to bill for certain COVID-19 lab tests, including serology tests. CMS has updated its guidance to include payment details for additional CPT codes created by the American Medical Association. There is no cost-sharing for Medicare patients.

Guidance

May 19, 2020

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update — Revised

A revised MLN Matters Article MM11661 on Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update (PDF) is available. Learn about revised relative value units for codes 99441, 99442, and 99443 and additional information for codes G2025 and G0071.


How to Use the Medicare Coverage Database — Revised

A revised How to Use The Medicare Coverage Database Medicare Learning Network Booklet is available. Learn how to:

  • Navigate the database
  • Search indexes
  • Download reports

Medicare Clarifies Recognition of Interstate License Compacts

A new MLN Matters Special Edition Article SE20008 on Medicare Clarifies Recognition of Interstate License Compacts (PDF) is available. Learn about recognition of interstate license compacts as valid and full licenses.


Extension of Payment for Section 3712 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act)

A new MLN Matters Article MM11784 on Extension of Payment for Section 3712 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) (PDF) is available. Learn about implementation of the new April 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule amounts.


International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--October 2020 Update

A new MLN Matters Article MM11749 on International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--October 2020 Update (PDF) is available. Learn about updated ICD-10 conversions and codes.


Influenza Activity in Massachusetts

Figure 1 shows that for MMWR week 19, the percent of Influenza-Like Illness (ILI, defined by fever >100°F and cough and/or sore throat) visits at sentinel outpatient facilities continued to decrease this week but remains higher than the previous two years in the same week. COVID-19 related activity, as well as increased healthcare-seeking behavior for respiratory illness, contributes to the over COVID-19 related activity, as well as increased healthcare-seeking behavior for respiratory illness, contributes to the increase in overall ILI trends in recent weeks.

ILI Activity in Massachusetts by Region

Figure 4 shows the relative intensity of reported ILI activity in Massachusetts by region. Although regions may not all experience the same intensity of ILI at similar times, infections due to influenza can be found throughout Massachusetts during flu season. Figure 4 shows the West region is reporting high ILI activity, the Central region is reporting low ILI activity, and all other regions are reporting minimal ILI activity.

For more information about flu, go to our Weekly Flu Report.

COVID-19: Office Hours Call — May 14
Thursday, May 14 from 5-6pm

Hospitals, health systems, and providers: Ask CMS questions about our temporary actions that empower you to:

Increase hospital capacity – CMS Hospitals Without Walls
Rapidly expand the health care workforce
Put patients over paperwork
Promote telehealth
To Participate:

Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
Or, call 833-614-0820; Access Passcode: 5688374


COVID-19: Lessons from the Front Lines Call — May 15
Friday, May 15 from 12:30 to 2pm

These weekly calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians: Share your experience, ideas, strategies, and insights related to your COVID-19 response. There is an opportunity to ask questions.

To Participate:

Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
Or, call 877-251-0301; Access Code: 8983296

For More Information:

Coronavirus.gov
CMS Current Emergencies website
Podcast and Transcripts webpage: Audio recordings and transcripts

May 13, 2020

AAFP advocating for financial relief for Family Physicians

https://www.aafp.org/patient-care/emergency/2019-coronavirus/financial-relief.html


Telehealth Codes covered by CMS

An Excel spreadsheet that represents all codes covered by CMS for telehealth is available.

May 12, 2020

Mental Health in a Time of COVID-19 Webinar Series was launched. Part 1: Preparing Leaders to Address the Challenges was Recorded.

You can Register Here for Part 2: When Trauma, Fear, Anxiety Become Overwhelming, scheduled for Tuesday, May 12, 12:00pm. 

As a result of COVID-19, many may experience increases in negative emotions like fear and anxiety. For some, the event may be traumatic in and of itself or lead to individuals remembering trauma from the past. Faith and community leaders themselves may even be experiencing some of these challenges. This webinar will help participants know how to acknowledge and respond to higher levels of fear and anxiety in individuals. It will also help leaders ask the appropriate questions to consider the impact of trauma in people’s lives. Lastly, it will suggest strategies for how faith and community leaders can respond.



CMS Releases Additional Waivers for Hospitals and Other Facilities 

CMS continues to release waivers for the healthcare community that provide the flexibilities needed to take care of patients during the COVID-19 public health emergency (PHE). CMS recently provided additional blanket waivers for the duration of the PHE that:

  • Expand hospitals’ ability to offer long-term care services (“swing beds”);
  • Waive distance requirements, market share, and bed requirements for Sole Community Hospitals;
  • Waive certain eligibility requirements for Medicare-Dependent, Small Rural Hospitals (MDHs); and
  • Update specific life safety code requirements for hospitals, hospice, and long-term care facilities.

Emergency Declaration Blanket Waivers



Telehealth Video: Medicare Coverage and Payment of Virtual Services

CMS updated a video that answers common questions about the expanded Medicare telehealth services benefit during the COVID-19 public health emergency. New information includes how CMS adds services to the list of telehealth services, additional practitioners that can provide telehealth services, and the distant site services that Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can provide. Further, the video includes information about audio-only telehealth services, telehealth services that hospitals, nursing homes and home health agencies can provide, along with how to correctly bill for telehealth services.



Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 Testing

CMS published information for pharmacies and other suppliers that wish to enroll in Medicare temporarily as independent clinical diagnostic laboratories to help address the need for COVID-19 testing. Interested pharmacies and suppliers will need to apply for a Clinical Laboratory Improvement Amendments (CLIA) certificate. CMS wants to ensure that laboratories located in the United States applying for a CLIA certificate are able to begin testing for COVID-19 as quickly as possible.

MLN Matters Article



CMS Gives States Additional Flexibility to Address Coronavirus Pandemic

CMS has approved over 175 requests for state relief in response to the COVID-19 pandemic, including recent approvals for Alabama, Alaska, California, District of Columbia, Georgia, Maine, Massachusetts, Minnesota, Mississippi, Montana, Nebraska, New Mexico, Oregon, South Carolina, Rhode Island, Tennessee, Virginia, and Wisconsin. These approvals help to ensure that states have the tools they need to combat COVID-19 through a wide variety of waivers, amendments, and Medicaid state plan flexibilities, including support for programs that care for the elderly and people with disabilities. CMS developed a toolkit to expedite the application and review of each request and has approved these requests in record time. These approved flexibilities support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

Section 1135 Waivers

Section 1115(a) Waivers

1915(c) Waiver Appendix K Amendments

Medicaid State Plan Amendments

CHIP State Plan Amendments


What We Are Learning About Patient and Provider Experiences with Telehealth - by Barbra G. Rabson

I have been amazed and inspired to see healthcare respond to the daily challenges presented by the COVID-19 pandemic. Crises have a way of opening new opportunities and presenting innovative solutions which were barely conceivable before. So I believe it is with telehealth.

As I wrote in a post on April 13, we in healthcare have an enormous opportunity – I even see it as an obligation – to come out of this crisis with as much insight as possible to help us finally get telehealth right. Toward that end, MHQP has been interviewing patients and providers about their experiences with telehealth – and we are learning a lot. 

READ MORE

May 7, 2020

CMS COVID-19 Office Hours Call

Thursday, May 7th at 5:00 – 6:00PM

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 1181167

Audio Webcast link



CMS COVID-19 Lessons from the Front Lines:

Friday, May 8th at 12:30 – 2:00PM

Toll Free Attendee Dial-In: 877-251-0301; Access Code: 9146779

Web Link

Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

To listen to the audio files and read the transcripts for the COVID-19 Stakeholder calls, visit the Podcast and Transcripts page.



AAFP COVID-19 Member Exchange – New Amazon Site for Medical Supplies and PPE:

Amazon Business has created a website specifically for the purchase of medical supplies and PPE. All you need to do is login with or create an Amazon Business account. If you create a new account it can take up to 48 hours to be pre-vetted and given permission to purchase through the site. Learn more in the AAFP COVID-19 Member Exchange.



AAFP CME Updates: Managing the COVID-19 Crisis: A Nursing Facility Physician’s Perspective

As COVID-19 infections spike across the country, the impact of outbreaks among vulnerable patients in nursing facilities remain a major concern. Join Course Chair Nina Ahmad, MD, and Everett Schlam MD, for "Managing the COVID-19 Crisis: A Nursing Facility Physician's Perspective", to hear his experiences in trying to prevent patient exposure, structure resources to provide appropriate care management of patients with mild symptoms, and implementing appropriate precautions to protect staff in a nursing home environment.

Viewers can ask their questions live and earn 1 CME credit for participating. In addition, we encourage you to reply to this thread with any questions you would like to pose to our guest participants.

Join the live webinar on Friday, May 8th at 8pm via the links below:

Facebook

YouTube

Twitter

AAFP continues to add new CME sessions on COVID-19 topics regularly here, where you can find links to previous COVID-19 CME webinars as well as the extensive COVID-19 Pandemic Self-Study Series. All of these activities are free to AAFP members. On May 12th, a new session on COVID-19 Testing will launch in the self-study series.  Please let AAFP know if there are Pandemic related topics you feel we should address in our CME sessions that we haven't.

May 6, 2020

CMS increases payment rates for audio-only telehealth

The CMS has increased reimbursement rates for audio-only telemedicine to match those for in-person visits, a move the AAFP has supported since the beginning of the COVID-19 pandemic. The Academy and other medical groups sent a letter to congressional leaders saying flexibility was needed to ensure care for vulnerable populations, noting that some patients, including seniors, have access to phones but not video-enabled telehealth apps.  Read More

May 5, 2020

Reminder: CDC has most up to date COVID-19 Information

For the most up to date information on COVID-19 please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html. Please note: The COVID-19 pandemic is affecting healthcare seeking behavior. The number of persons and their reasons for seeking care in the outpatient and ED settings is changing. These changes impact data from ILINet in ways that are difficult to differentiate from changes in illness levels, therefore ILINet data should be interpreted with caution. More detailed interpretation of data and more COVID-19 specific information can be found in COVIDView.

May 4, 2020

National Academy of Science: Helping People With Addiction Stay Connected During COVID-19 (Webinar #1)

May 7, 2020 | 11am to 12:30pm https://nam.edu/programs/action-collaborative-on-countering-the-u-s-opioid-epidemic/treatment-webinar-series/

This free 90-minute webinar will provide insights on issues of access to addiction treatment and targeted guidance on how to effectively keep patients connected to treatment during the COVID-19 pandemic. This webinar has been approved for 1.5 hours of AMA PRA Category 1 credits.



CMS Medical Learning Network: New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE) MLN Matters Article

A revised Medical Learning Network Matters Special Edition Article SE20016 on New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE) is available. Learn new information on billing for distant site telehealth services during the COVID-19 PHE, including:

·         New telehealth services that can be provided by RHCs and FQHCs, including audio only telephone evaluation and management services

·         Revised bed count methodology for determining the exemption to the RHC payment limit for provider-based RHCs.



Rasky Partners Releases Updated Briefing May 1st: Update on Federal Stimulus Efforts in Response to COVID-19

Rasky Partners continues to be immersed in how the federal government is responding to the COVID-19 pandemic and what that means for various stakeholders. For the latest information, intelligence and analysis regarding additional stimulus efforts in a concise, easy to understand briefing, click here.



New Frequently Asked Questions on EMTALA

CMS issued Frequently Asked Questions (FAQs) clarifying requirements and considerations for hospitals and other providers related to the Emergency Medical Treatment and Labor Act (EMTALA) during the COVID-19 pandemic. The FAQs address questions around patient presentation to the emergency department, EMTALA applicability across facility types, qualified medical professionals, medical screening exams, patient transfer and stabilization, telehealth, and other topics.

Frequently Asked Questions



Dear Clinician: CMS Adds New COVID-19 Clinical Trials Improvement Activity to the Quality Payment Program

CMS issued a letter thanking clinicians for their ongoing efforts to treat patients and combat COVID-19 and shared additional details on the new Merit-Based Incentive Payment System (MIPS) improvement activity. As announced earlier this month, clinicians who participate in a COVID-19 clinical trial and report their findings to a clinical data repository or registry many now earn credit in MIPS under the Improvement Activities performance category for the 2020 performance period by attesting to this new activity.

Dear Clinician Letter

April 29, 2020

Reminder from AAFP: Town Hall tonight | Earn CME

COVID-19 has exposed some of the health disparities that exist in the U.S. Join AAFP President Gary LeRoy MD, Santina Wheat MD, AAFP Director, Center for Diversity and Health Equity Danielle Jones and me tomorrow at 8 p.m. We'll discuss the social, economic and health inequities that place vulnerable populations at an increased risk of complications from COVID-19 and identify potential mitigation strategies for improving health outcomes in this group during the pandemic.

Viewers can ask their questions live and earn 1 CME credit for participating. In addition, we encourage you to reply to this thread with any questions you would like to pose to our guest participants.

 You can join the Town Hall via the links below:

Facebook

Youtube

Twitter



CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program

On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to health care providers and suppliers through these programs and in light of the $175 billion recently appropriated for health care provider relief payments.

CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the 2019 Novel Coronavirus (COVID-19). Funding will continue to be available to hospitals and other health care providers on the front lines of the coronavirus response primarily from the Provider Relief Fund. The Accelerated and Advance Payment (AAP) Programs are typically used to give providers emergency funding and address cash flow issues for providers and suppliers when there is disruption in claims submission or claims processing, including during a public health emergency or Presidentially-declared disaster.

Since expanding the AAP programs on March 28, 2020, CMS approved over 21,000 applications totaling $59.6 billion in payments to Part A providers, which includes hospitals. For Part B suppliers, including doctors, non-physician practitioners and durable medical equipment suppliers, CMS approved almost 24,000 applications advancing $40.4 billion in payments. The AAP programs are not a grant, and providers and suppliers are typically required to pay back the funding within one year, or less, depending on provider or supplier type. Beginning today, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through the Department of Health & Human Services’ (HHS) Provider Relief Fund.

Significant additional funding will continue to be available to hospitals and other health care providers through other programs. Congress appropriated $100 billion in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (PL 116-136) and $75 billion through the Paycheck Protection Program and Health Care Enhancement Act (PL 116-139) for health care providers. HHS is distributing this money through the Provider Relief Fund, and these payments do not need to be repaid.

The CARES Act Provider Relief Fund is being administered through HHS and has already released $30 billion to providers and is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. This funding will be used to support health care-related expenses or lost revenue attributable to the COVID-19 pandemic and to ensure uninsured Americans can get treatment for COVID-19.

For more information on the CARES Act Provider Relief Fund and how to apply, visit: hhs.gov/providerrelief.

For an updated fact sheet on the Accelerated and Advance Payment Programs, visit: https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf.

April 28, 2020

CMS Releases COVID-19 Toolkit to Accelerate State Use of Telehealth in Medicaid and CHIP

CMS released a new toolkit for states to help accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs (CHIP) during the COVID-19 pandemic. The toolkit will help states identify policies that may impede the rapid deployment of telehealth when providing care. This release builds on the agency’s swift actions to ensure that Americans can access the health care services they need through electronic and virtual means, minimizing travel to healthcare facilities and supporting efforts to limit community spread of the virus.

Press Release

Toolkit



Ventilator Management and the COVID-19 Crisis: What Family Physicians Need to Know

With the rise in COVID-19 cases and the need for surge planning, acquiring basic ventilator management skills is now essential for many family physician learners. AAFP is adding additional CME activities each week here. In addition, new information to our journal website is added each day, including a daily COVID-19 research brief here.



Enrichment Credit

We know that you are diligently working to keep up on COVID-19. Did you know that all of the reading and independent study that you are doing can be counted as CME credit? This independent study can be claimed as Professional Enrichment credit. Simply go to www.aafp.org/mycme choose the Report CME tab and look for Professional Enrichment in the Self-Directed Learning Activities section. Limited to 25 AAFP Elective credits per three-year re-election cycle.

April 20, 2020

CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19

Sunday, April 19, the Centers for Medicare & Medicaid Services issues new recommendations specifically targeted to communities that are in Phase 1 of the Guidelines for President Trump’s Opening Up America Again with low incidence or relatively low and stable incidence of COVID-19 cases. The recommendations update earlier guidance provided by CMS on limiting non-essential surgeries and medical procedures. The new CMS guidelines recommend a gradual transition and encourage health care providers to coordinate with local and state public health officials, and to review the availability of personal protective equipment (PPE) and other supplies, workforce availability, facility readiness, and testing capacity when making the decision to re-start or increase in-person care.

The new recommendations can be found here.

The Guidelines for Opening Up America Again can be found here.

April 16, 2020

AAFP Discount for Interact’s Telehealth Rapid Ramp-Up Online Course

With the COVID-19 Pandemic, the need to quickly provide quality telehealth services grows every day. For Primary Care Physicians, telehealth not only protects the communities you serve, but also provides additional income while office visits are down as a result of stay-at-home orders in effect across the country.  At Interact, we recognize this need and would like to extend an offer to AAFP members during these trying times. That’s why we are offering 20% off our $49, 30-minute Telehealth Rapid Ramp-Up Course to members using the code AAFPsaves at checkout.  Whether you are new to telehealth or are already providing those services to your patients, there is something to gain from taking this 30-minute online course. Telehealth is here to stay, and most providers don’t just want to “do” telehealth, they want to do it well. Our course focuses on the aspects of providing telehealth that may not come naturally to providers but are a major part of the patient experience.

Use code AAFP saves at checkout to receive 20% off our $49 Telehealth Online Course!


Trump Administration Announces Expanded Coverage for Essential Diagnostic Services Amid COVID-19 Public Health Emergency

CMS, together with the Departments of Labor and the Treasury, issued guidance to ensure Americans with private health insurance have coverage of COVID-19 diagnostic testing and certain other related services, including antibody testing, at no cost. This includes urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office that result in an order for or administration of a COVID-19 test. As part of the effort to slow the spread of the virus, this guidance is another action the Trump Administration is taking to remove financial barriers for Americans to receive necessary COVID-19 tests and health services, as well as encourage the use of antibody testing that may help to enable health care workers and other Americans to get back to work more quickly.

Press Release
Guidance


You are invited to CMS “Office Hours” on COVID-19, Thursday, April 16th from 5:00 – 6:00 PM, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

  • Increase Hospital Capacity – CMS Hospitals Without Walls
  • Rapidly Expand the Healthcare Workforce
  • Put Patients Over Paperwork
  • Further Promote Telehealth in Medicare
  • We encourage you to submit questions in advance to partnership@cms.hhs.gov, including “Office Hours” in the subject line. There will also be live Q&A

Dial in details are below:

Toll-Free Attendee Dial In: 833-614-0820

Event Plus Passcode: 6168487

Audio Webcast link

Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. 

You are welcome to share this invitation with your colleagues and membership.

These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.


Baker: Mass. Investing $800M into Healthcare Providers Impacted by Coronavirus Pandemic

Governor Baker announced a new infusion of $800 million at MassHealth in critical stabilization funding to support health care providers impacted by and responding to COVID-19. While announcing this, the Governor said that health care providers across the Commonwealth have stepped up in unprecedented ways in the past few weeks while experiencing a significant impact on their revenue and operations.

This funding is meant to support hospitals, nursing facilities, primary care providers, behavioral health providers, and long-term services and supports providers and will be distributed starting this month and through July.

Some member’s practices will see a 15% rate increase on a broad range of physician codes for Medicaid services, which will be applied effective 4/1/20-7/31/20.

Details will be communicated as soon as it is available.

April 14, 2020

CMS Office Hours on COVID-19 - April 14

You are invited to CMS “Office Hours” on COVID-19, Tuesday, April 14th from 5:00 – 6:00 PM, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

  • Increase Hospital Capacity – CMS Hospitals Without Walls;
  • Rapidly Expand the Healthcare Workforce;
  • Put Patients Over Paperwork; and
  • Further Promote Telehealth in Medicare

Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

Toll-Free Attendee Dial In: 833-614-0820

Event Plus Passcode: 2395745

Audio Webcast link

You can find a copy of the full press release and related materials here.

To keep up with the important work the White House Task Force is doing in response to COVID-19, please click here: www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

April 13, 2020

COVID-19: Dear Clinician Letter

CMS posted a letter to clinicians that outlines a summary of actions CMS has taken to ensure clinicians have maximum flexibility to reduce unnecessary barriers to providing patient care during the unprecedented outbreak of COVID-19. The summary includes information about telehealth and virtual visits, accelerated and advanced payments, and recent waiver information.
Letter (PDF)


 
CMS Issues New Wave of Infection Control Guidance to Protect Patients and Healthcare Workers from COVID-19

CMS issued a series of updated guidance documents focused on infection control to prevent the spread of the 2019 Novel Coronavirus (COVID-19) in a variety of inpatient and outpatient care settings. The guidance, based on Centers for Disease Control and Prevention (CDC) guidelines, will help ensure infection control in the context of patient triage, screening and treatment, the use of alternate testing and treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning and disinfection guidelines, staffing, and more.

 Press Release


Updated Questions and Answers on COVID-19 

Review CMS’ updated FAQs to equip the American health care system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. Check this resource often as CMS updates it on a regular basis - we insert the date at the end of each FAQ when it is new or updated.


Using CS Modifier When Cost-Sharing is Waived 

This clarifies a prior message that appeared in our April 7, 2020 Special Edition.

CMS now waives cost-sharing (coinsurance and deductible amounts) under Medicare Part B for Medicare patients for certain COVID-19 testing-related services.  Previously, CMS made available the CS modifier for the gulf oil spill in 2010; however, CMS recently repurposed the CS modifier for COVID-19 purposes. Now, for services furnished on March 18, 2020, and through the end of the Public Health Emergency, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under specific payment systems outlined in the April 7 message should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and to get 100% of the Medicare-approved amount.  Additionally, they should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services.


Medicare FFS Claims: 2% Payment Adjustment Suspended (Sequestration)

Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act temporarily suspends the 2% payment adjustment currently applied to all Medicare Fee-For-Service (FFS) claims due to sequestration. The suspension is effective for claims with dates of service from May 1 through December 31, 2020.


Trump Administration Acts to Ensure U.S. Healthcare Facilities Can Maximize Frontline Workforces to Confront COVID-19 Crisis

At President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) today temporarily suspended a number of rules so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs as they fight to save lives during the 2019 Novel Coronavirus (COVID-19) pandemic.

These changes affect doctors, nurses, and other clinicians nationwide, and focus on reducing supervision and certification requirements so that practitioners can be hired quickly and perform work to the fullest extent of their licenses. The new waivers sharply expand the workforce flexibilities CMS announced on March 30.

For a fact sheet detailing additional information on the waivers announced today and previously, click here.



Pneumococcal Pneumonia Vaccination: Eligibility Transactions Includes DOS Starting April 13

Starting April 13, CMS beneficiary eligibility transactions will return the Pneumococcal Pneumonia Vaccination (PPV) Date(s) of Service (DOS) for HCPCS codes 90670 and 90732 when a beneficiary has already received the service. Eligibility transactions will also return the related National Provider Identifier (NPI): Institutional NPI for Part A or rendering NPI for Part B to help you better coordinate care. See the MLN Matters Article (PDF) for more information.


Quality Payment Program: MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19

CMS is offering multiple flexibilities to provide relief to clinicians responding to the 2019 Novel Coronavirus (COVID-19) pandemic. In addition to extending the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline to April 30 at 8 pm ET, the MIPS automatic extreme and uncontrollable circumstances policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30 deadline.

If you are a MIPS eligible clinician and do not submit any MIPS data by April 30, you will not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. You will be automatically identified and will receive a neutral payment adjustment for the 2021 MIPS payment year. Note: We updated the Participation Status Tool, so you can see if the policy is automatically applied.

We are also reopening the MIPS extreme and uncontrollable circumstances application for individuals, groups, and virtual groups. An application submitted by April 30, citing COVID-19 will override any previous data submission.

For More Information:


CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week

The Centers for Medicare & Medicaid Services (CMS) has delivered nearly $34 billion in the past week to the health care providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.

“Health care providers are making massive financial sacrifices to care for the influx of coronavirus patients,” said CMS Administrator Seema Verma. “Many are rightly complying with federal recommendations to delay non-essential elective surgeries to preserve capacity and personal protective equipment. They shouldn’t be penalized for doing the right thing. Amid a public health storm of unprecedented fury, these payments are helping providers and suppliers – so critical to defeating this terrible virus – stay afloat.”

The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks. In a little over a week, CMS has received over 25,000 requests from health care providers and suppliers for accelerated and advance payments and have already approved over 17,000 of those requests in the last week. Prior to COVID-19, CMS had approved just over 100 total requests in the past five years, with most being tied to natural disasters such as hurricanes.

The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners, and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.

The CMS Accelerated and Advance Payment Program is funded from the Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) trust funds, which are the same funds used to pay out Medicare claims each day. The advance and accelerated payments are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement. The majority of hospitals including inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals will have up to one year from the date the accelerated payment was made to repay the balance. All other Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively.

It is important to note, this funding is separate from the $100 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act appropriation is a payment that does not need to be repaid. The Department of Health and Human Services (HHS) will be providing additional information on how health care providers and suppliers can access CARES Act funds in the coming weeks.

The fact sheet on the accelerated/advance payment process and how to submit a request can be found here: Fact Sheet (PDF). Providers can also contact their Medicare Administrative Contractor for any questions.

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.


 
COVID-19: Non-Emergent, Elective Medical Services and Treatment Recommendations

CMS recently updated recommendations to postpone non-essential surgeries and other procedures to conserve critical health care resources and limit exposure of patients and staff to COVID-19. Developed in collaboration with medical societies and associations, the recommendations outline a tiered approach for state and local officials, clinicians, and delivery systems to consider to prioritize services and care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition.
Recommendations 


RASKY PARTNERS RELEASES UPDATED BRIEFING - Small & Medium-Sized Business & Nonprofit Relief within COVID-19 Stimulus Package

Our DC team continues to be immersed in how the federal government is responding to the COVID-19 pandemic and what that means for businesses, nonprofits and others. We have pulled together the latest information, intelligence and analysis regarding additional stimulus efforts in a concise, easy to understand briefing and will continue to send updates as these federal efforts continue to develop.  

Please click here to access the briefing. 

April 9, 2020

CMS Office Hours on COVID-19: April 9th

You are invited to CMS “Office Hours” on COVID-19, Thursday, April 9th from 5:00 – 6:00 PM, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

  • Increase Hospital Capacity – CMS Hospitals Without Walls
  • Rapidly Expand the Healthcare Workforce
  • Put Patients Over Paperwork
  • Further Promote Telehealth in Medicare

We encourage you to submit questions in advance to partnership@cms.hhs.gov, including “Office Hours” in the subject line. There will also be live Q&A.

Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

Toll-Free Attendee Dial In: 833-614-0820

Event Plus Passcode: 1881716

Audio Webcast link

You can find a copy of the full press release and related materials here.

To keep up with the important work the White House Task Force is doing in response to COVID-19, please click here: www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

April 7, 2020

Lessons from The Front Lines: Listen to recorded call hosted by CMS Administrator

On April 3, CMS Administrator Seema Verma, Deborah Birx, MD, White House Coronavirus Task Force, and officials from the FDA, CDC, and FEMA participated in a call on COVID-19 Flexibilities. Several physician guests on the front lines presented best practices from their COVID-19 experience(s). You can listen to the conversation here.


Opportunities for COVID-19 related CME activities

AAFP has been developing additional CME accredited activities regularly including the Town Hall sessions, self-study case studies, and a webinar series. Links to all these COVID-19 related activities can be found here.  AAFP will continue to add more CME activities each week.


New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.


COVID-19: Expanded Use of Ambulance Origin/Destination Modifiers

During the COVID-19 Public Health Emergency, Medicare will cover a medically necessary emergency and non-emergency ground ambulance transportation from any point of origin to a destination that is equipped to treat the condition of the patient consistent with state and local Emergency Medical Services (EMS) protocols where the services will be furnished. On an interim basis, we are expanding the list of destinations that may include but are not limited to:

Any location that is an alternative site determined to be part of a hospital, Critical Access Hospital (CAH), or Skilled Nursing Facility (SNF)

  • Community mental health centers
  • Federally Qualified Health Centers (FQHCs)
  • Rural health clinics (RHCs)
  • Physicians’ offices
  • Urgent care facilities
  • Ambulatory Surgery Centers (ASCs)
  • Any location furnishing dialysis services outside of an End-Stage Renal Disease (ESRD) facility when an ESRD facility is not available
  • Beneficiary’s home

CMS expanded the descriptions for these origin and destination claim modifiers to account for the new covered locations:

  • Modifier D - Community mental health center, FQHC, RHC, urgent care facility, non-provider-based ASC or freestanding emergency center, location furnishing dialysis services and not affiliated with ESRD facility
  • Modifier E – Residential, domiciliary, custodial facility (other than 1819 facility) if the facility is the beneficiary’s home
  • Modifier H - Alternative care site for hospital, including CAH, provider-based ASC, or freestanding emergency center
  • Modifier N - Alternative care site for SNF
  • Modifier P - Physician’s office
  • Modifier R - Beneficiary’s home

For the complete list of ambulance origin and destination claim modifiers see Medicare Claims Processing Manual Chapter 15, Section 30 A.

April 6, 2020

New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.  See video here.

April 2, 2020

Recordings for CMS National Stakeholder Calls on COVID-19

CMS has been hosting regular calls with a variety of clinicians, hospitals, and other facilities in an effort to keep stakeholders updated on our COVID-19 efforts.  As we know not everyone is available to attend the calls live, we are happy to share that you can access recordings of the calls along with transcripts on the following link. We will continue to host calls and share information through our list serves and media. 

To keep up with the important work of the White House Coronavirus Task Force in response to COVID-19, visit https:/www.coronavirus.gov.  For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

April 1, 2020

Rasky Partner’s briefing small business assistance:  Rasky Partners is one of the leading independent public relations and public affairs firms in the nation. Teams of experts are located in Washington D.C. and Boston and they offer clients strategic communications and public affairs counsel. Their team in the DC office has reviewed the COVID-19 Stimulus Package that was passed by the Federal Government and put together the attached document that details the relief opportunities for small/medium sized businesses and non-profits.  Read More

CMS Granting Key Flexibilities:  Yesterday, CMS released an array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. These temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. The new rules allow hospitals and health systems to deliver services at other locations to make room for COVID-19 patients needing acute care in their main facility. CMS also posted a complete summary of the flexibilities provided to all physicians and clinicians to help clarify current allowable and billable practices. CMS also approved two additional Section 1135 waivers today, bringing the total of approved waivers to 40 states.

Granting Financial Relief for Medicare Providers: Over the weekend, CMS provided financial relief to Medicare providers by expanding their accelerated and advance payment program to help ensure that they have resources needed to combat COVID-19. Accelerated and advance Medicare payments provide emergency funding and addresses cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.  The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers.

March 31, 2020

Medicare Payment for Telephone (only) Visits

Earlier today, the Centers for Medicare and Medicaid Services (CMS) announced a series of changes to Medicare benefit and payment policies.  Included in the announcement was a change in payment policy whereby CMS will begin paying for telephone-only visits conducted by physicians.  

Achieving this change in payment policy has been a priority for the AAFP and we specifically requested this policy change in a letter to CMS.

You can read about the new CMS policies here.

The AAFP will have more information and guidance on this change in payment policy today. This will be important, for example, because CMS is not permitting 99211-215 services via telehealth audio only, they are paying for previously non-billable telephone visit codes 99441-43.

You may want to add your home address to your Medicare Enrollment if you are providing telehealth services from your home.

  1. Can the distant site practitioner furnish Medicare telehealth services from their home? Or do they have to be in a medical facility?

There are no payment restrictions on distant site practitioners furnishing Medicare telehealth services from their home. The practitioner is required to update their Medicare enrollment with the home location. The practitioner can add their home address to their Medicare enrollment file by reaching out to the Medicare Administrative Contractor in their jurisdiction through the provider enrollment hotline. It would be effective immediately so practitioners could continue providing care without a disruption. More details about this enrollment requirement can be found at 42 CFR 424.516. If the physician or non-physician practitioner reassigns their benefits to a clinic/group practice, the clinic/group practice is required to update their Medicare enrollment with the individuals’ home location. The clinic/group practice can add the individual’s home address to their Medicare enrollment file by reaching out to the Medicare Administrative Contractor in their jurisdiction through the provider enrollment hotline.

March 30, 2020

Accelerated/Advance Payments for Medicare Providers

On March 28 the Centers for Medicare and Medicaid Services (CMS) announced that they would immediately implement a new Accelerate and Advance Medicare Payment policy to assist family physicians and other Medicare Part A and Part B providers and suppliers. Again, family physicians who meet the qualifying criteria are eligible for these accelerated and advanced Medicare payments.  This is the policy that the AAFP asked CMS to implement earlier this week.

Medicare will start accepting and processing the Accelerated/Advance Payment Requests immediately. CMS anticipates that the payments will be issued within seven days of the provider’s request.    Here is information on how to apply – you must go through your regional contractor

FACT SHEET: EXPANSION OF THE ACCELERATED AND ADVANCE PAYMENTS PROGRAM FOR PROVIDERS AND SUPPLIERS DURING COVID-19 EMERGENCY

You can find a copy of the fact sheet here.

You can find a copy of the press release here.



Quality Payment Program and Quality Reporting Program/Value Based Purchasing Program COVID-19 Relief

On March 22, 2020, CMS announced relief for clinicians, providers, hospitals and facilities participating in quality reporting programs in response to the 2019 Novel Coronavirus (COVID-19). This memorandum and factsheet supplements and provides additional guidance to health care providers with regard to the announcement. CMS has extended the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline from March 31 by 30 days to April 30, 2020. This and other efforts are to provide relief to clinicians responding to the COVID-19 pandemic. In addition, the MIPS automatic extreme and uncontrollable circumstances policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30, 2020 deadline.

You can find a copy of the memo here:  Memo

You can find a copy of the fact sheet here:  Fact Sheet


 

Updates from CMS re: Enrollment Relief, Open Payments, Beneficiary Notices:

2019-Novel Coronavirus (COVID-19) Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs)

CMS released Frequently Asked Questions on Medicare Provider Enrollment Relief related to COVID-19 including the toll-free hotlines available to Medicare Administrative Contractors (MACs). CMS has established toll-free hotlines at each MAC to allow physicians and non-physician practitioners to initiate temporary Medicare billing privileges. These hotlines provide expedited enrollment and answer questions related to COVID-19 enrollment requirements. FAQ

Frequently Asked Questions (FAQs) on Enforcing Open Payments Deadlines

CMS released an updated comprehensive list of Frequently Asked Questions (FAQs) about the Open Payments program. Tuesday, March 31, 2020 is the Open Payments Program Year 2019 data submission deadline for applicable manufacturers and group purchasing organizations (GPOs) to submit and attest to data for the June 2020 publication of Program Year 2019 data. The deadline cannot be extended past March 31, 2020, therefore, CMS will exercise enforcement discretion for submissions completed after the statutory deadline due to circumstances beyond the reporting entity’s control related to the pandemic. FAQ

Beneficiary Notice Delivery Guidance in light of COVID-19

If you are treating a patient with suspected or confirmed COVID-19, CMS encourages the provider community to be diligent and safe while issuing the following beneficiary notices to beneficiaries receiving institutional care:

  • Important Message from Medicare   (IM)_CMS-10065
  • Detailed Notices of Discharge   (DND)_CMS-10066
  • Notice of Medicare Non-Coverage   (NOMNC)_CMS-10123
  • Detailed Explanation of Non-Coverage   (DENC)_CMS-10124
  • Medicare Outpatient Observation Notice   (MOON)_CMS-10611
  • Advance Beneficiary Notice of Non-Coverage   (ABN)_CMS-R-131
  • Skilled Nursing Advance Beneficiary Notice of Non-Coverage   (SNFABN)_CMS-10055
  • Hospital Issued Notices of Non-Coverage   (HINN)

In light of concerns related to COVID-19, current notice delivery instructions provide flexibilities for delivering notices to beneficiaries in isolation. These procedures include: 

  • Hard copies of notices may be dropped off with a beneficiary by any hospital worker able to enter a room safely. A contact phone number should be provided for a beneficiary to ask questions about the notice, if the individual delivering the notice is unable to do so. If a hard copy of the notice cannot be dropped off, notices to beneficiaries may also delivered via email, if a beneficiary has access in the isolation room. The notices should be annotated with the circumstances of the delivery, including the person delivering the notice, and when and to where the email was sent.
  • Notice delivery may be made via telephone or secure email to beneficiary representatives who are offsite. The notices should be annotated with the circumstances of the delivery, including the person delivering the notice via telephone, and the time of the call, or when and to where the email was sent.

We encourage the provider community to review all of the specifics of notice delivery, as set forth in Chapter 30 of the Medicare Claims Processing Manual. https://www.cms.gov/media/137111

CMS has taken several recent actions in response to the Coronavirus Disease 2019 (COVID-19), as part of the ongoing White House Task Force efforts.  A summary of recent CMS activities can be found here: https://www.cms.gov/newsroom/press-releases/cms-news-alert-march-26-2020

To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For information specific to CMS, please visit the CMS News Room and Current Emergencies Website.

March 25, 2020

Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19


On March 22, CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19).

CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for several CMS programs. For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report.

CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions, and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period.

You can find a copy of the press release here.

CMS will continue monitoring the developing COVID-19 situation and assess options to provide additional relief to clinicians, facilities, and their staff so they can focus on caring for patients.

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, please visit the coronavirus.gov webpage. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Webpage on CMS.Gov.

March 24, 2020

CMS Relaxes Quality Payment Program (QPP) (MIPS)

                The Centers for Medicare & Medicaid Services (CMS) has extended(www.cms.gov) the deadline to report data for the Merit-based Incentive Payment System (MIPS) 2019 performance year, as requested in a recent letter from the American Academy of Family Physicians. Practices now have until April 30, 2020, to submit data. The original deadline was March 31. This new deadline, part of the agency's response to COVID-19, also applies to participants in the Medicare Shared Savings Program (MSSP)


Administration for Community Living (a division of HHS): older adult related COVID-19 resources https://acl.gov/COVID-19

March 23, 2020

Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19

CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19)

CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for several CMS programs.  For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report. 

CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period. 

You can find a copy of the press release here.

CMS will continue monitoring the developing COVID-19 situation and assess options to additional relief to clinicians, facilities, and their staff so they can focus on caring for pat

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing i response to COVID-19, please visit www.coronavirus.gov. For a complete and updated l CMS actions, and other information specific to CMS, please visit the Current Emergencies Webpage on CMS.Gov

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