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BILLING & COLLECTIONS

Medicare covering OTC COVID-19 tests

Starting this week and through the end of the COVID-19 public health emergency (PHE), Medicare covers and pays for over-the-counter (OTC) COVID-19 tests at no cost to people with Medicare Part B, including those with Medicare Advantage (MA) plans. In addition to helping prevent the spread of COVID-19, the goal is to find out if Medicare payment for OTC COVID-19 tests will improve access to testing and result in Medicare savings or other program improvements. What’s covered Eligible providers or suppliers can distribute U.S. FDA-approved, authorized, or cleared OTC COVID-19 tests to patients enrolled in Part B, including those enrolled in MA plans. Patients who only have Medicare Part A can get free OTC COVID-19 tests through other government-led programs, like covidtests.gov, which operates through the United States Postal Service (USPS). Or,… . . . read more.

PATIENT ACCESS

AMA asks Congress to fix Medicare physician payment system

The American Medical Association (AMA) has warned congressional leaders that the Medicare Payment Advisory Commission (MedPAC) report sent to Congress in mid-March contains flawed analyses that would imperil patient access to high-quality care. The MedPAC report recommended a continuation of the freeze in Medicare physician fee payments but ignores a host of trailing indicators, none more obvious than the impact of the COVID-19 pandemic on physician practices. In 2020, there was a $13.9 billion decrease in Medicare physician fee schedule spending as patients delayed treatments. Burnout, stress, workload, and fear of COVID infection are leading one in five physicians to consider leaving their current practice within two years. The letter to Congress includes a chart—based on an analysis of data from the Medicare Trustees—that shows Medicare physician payment has been… . . . read more.

MOM WEBINAR

Learn about changes and updates to telehealth

There’s a lot you need to know about telehealth. That’s why Medical Office Manager is offering a webinar, Telehealth—What Managers Need to Know, on April 6. It’s free to Medical Office Manager members. Presenter Jen Bell of Karen Zupko and Associates will give you the tools and knowledge you need to comply with new telehealth regulations. Meanwhile here is Jen’s update on telehealth changes to early 2022. POS 10 Telehealth Provided in Patient’s Home Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. Home may be defined to include temporary lodging (hotels, homeless shelters) and patient travels of short distance from the exact… . . . read more.

FREE WEBINAR FOR MOM MEMBERS

What managers need to know as telehealth flexibilities carry on

Telehealth rules that were loosened during the pandemic are likely to stay that way for awhile. President Biden signed the Consolidated Appropriations Act of 2022 into law last week. Included in the law is an extension to some telehealth flexibilities for an additional five months (151 days) after the end of the current public health emergency (PHE). Flexibilities that will be extended include: Originating site and geographic location waivers—this allows patients to have a telehealth visit from their home (or another site) not just CMS designated originating sites Extends temporary qualifying providers (e.g., physical therapists, occupational therapists, speech language pathologists, audiologists, and dieticians) the option to furnish distant site services Mandates CMS to continue covering audio-only telehealth visits for Medicare beneficiaries Delays the in-person visit requirement for mental telehealth visits… . . . read more.

BILLING

Newly proposed Medicare Part B Physician Fee Schedule contemplates Making COVID-19 telehealth changes permanent

On July 13, 2021, CMS published its proposed physician fee schedule rule for FY 2022. One of the key items is the proposal to make the temporary change allowing Medicare providers to deliver healthcare services via telehealth a permanent part of Medicare Part B. The Proposed Medicare Changes During the public health emergency (PHE), Congress added the home of the beneficiary as a permissible originating site for telehealth services for the purposes of diagnosis, evaluation or treatment of a mental health disorder. In addition to updating the fee schedule, the proposed CY2022 rule would allow certain services added to the Medicare telehealth list to remain on the list until the end of December 2023. This would allow CMS to continue to evaluate whether the temporary expansion of telehealth services adopted… . . . read more.

BILLING

New federal rule to protect consumers from surprise medical bills

The Biden-Harris Administration has announced a rule to protect consumers from surprise medical bills. The U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans. “No patient should… . . . read more.

INCREASING PROFITS

Denial management: the missing ingredient in revenue cycle management

By John McDaniel The blueprint for effective Revenue Cycle Management (RCM) is complex in today’s healthcare environment. When we map out the RCM process, it includes the following steps: Patient scheduling and registration Insurance eligibility and benefit verification Collection of copayments and deductibles at time of service Claims submission Remittance processing Denial management Back‐end patient collections Denial Management Implementing an effective and efficient process for managing claim denials is likely the single most important action a healthcare organization can make to affect its revenue cycle. Denial management is by no means a simple process; in fact, it is often extremely complex. According to the American Academy of Family Physicians, the average claim denial rate across the healthcare industry is 5 to 10 percent, varying between specialties. With the average cost… . . . read more.

FALSE CLAIMS

Provider pays $214K for violating federal COVID-19 workplace protocols

In one of the first of what will likely be a flood of enforcement actions, the Texas parent of an Iowa nursing home has agreed to repay $214,200 in federal monies for not following coronavirus safety protocols during an outbreak at the facility from April through July 2020. Among other things, the nursing home didn’t properly screen employees or require them to wear personal protective equipment. According to newspaper reports, three employees exhibiting COVID-19 symptoms and who subsequently tested positive for the virus were allowed to come to work and be near vulnerable residents, 11 of whom died during the outbreak. The False Claims Act connection The relatively small settlement award belies the importance of this case. What the case illustrates is that failure to follow COVID-19 protocols can result… . . . read more.

GETTING PAID

Getting Medicare reimbursement for telehealth services: The new CONNECT for Health Act

Like most cliches, the one about the COVID-19 pandemic’s transformation of medicine forever is laden with truth. Telemedicine is Exhibit A. Of course, telemedicine goes back decades. But the pandemic accelerated the breakdown of resistance on the parts of providers, regulators and above all, patients. It was supposed to be just temporary. But to use still one more cliché, now that the toothpaste is out of the tube, it becomes a matter of figuring out how to regulate it effectively. Ironically, but hardly unexpectedly, one of Congress’ first attempts to impose systematic regulation involves recycling a piece of legislation that falabiled to gain support in pre-pandemic times but may make it into law this time. Here’s a quick overview of the so-called CONNECT for Health Act and what medical office… . . . read more.

REIMBURSEMENT

CMS reweighting 2020 MIPS cost performance category

The Centers for Medicare & Medicaid Services (CMS) recognizes the impact of the COVID-19 pandemic public health emergency (PHE) on clinicians across the country and continues to offer flexibilities to provide relief where possible. Under § 414.1350(d)(3), the Merit-based Incentive Payment System (MIPS) cost performance category weight is 15% of the final score for the 2020 performance period/2022 MIPS payment year. CMS wants all MIPS eligible clinicians to know it is reweighting the cost performance category from 15% to 0% for the 2020 performance period. The 15% cost performance category weight will be redistributed to other performance categories in accordance with § 414.1380(c)(2)(ii)(D). See the table below for reweighting scenarios. Analysis of the underlying data for the 2020 performance year, in comparison to prior years’ data, shows that the volume… . . . read more.


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