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You are here: Home / Archives for topics / Health care reform
BILLING & COLLECTIONS

Medicare covering OTC COVID-19 tests

April 4, 2022 by

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.

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MIPS

Submit your Promoting Interoperability measures and improvement activities

April 4, 2022 by

The Centers for Medicare & Medicaid Services (CMS) reminds you to submit Promoting Interoperability measures and improvement activities for consideration for future years of the Merit-based Incentive Payment System (MIPS). The MIPS Annual Call for Measures and Activities process allows clinicians, professional associations and medical societies that represent clinicians, researchers, consumer groups, and others to identify and submit measures and activities. Currently, CMS is accepting submissions for: Measures for the Promoting Interoperability performance category Activities for the improvement activities performance category What CMS is looking for For Promoting Interoperability: CMS is looking for specific measures that build on the advanced use of certified EHR technology (CEHRT) using 2015 Edition Certification Standards and Criteria; promote interoperability and health information exchange; improve program efficiency, effectiveness, and flexibility; provide patients access to their health information; reduce clinician… . . . read more.

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PATIENT ACCESS

Medical association happy with telehealth extensions

March 28, 2022 by

The American Medical Association (AMA) salutes Congress for passing telehealth provisions in the omnibus spending bill that promise a new era of access for patients across the country. “Congress has taken a crucial step in starting a revolution in patient access. The AMA aims to continue being a partner in moving it forward,” said AMA President Gerald E. Harmon, M.D. “The dramatic increase in adoption of telehealth that occurred in 2020 has allowed medical care that combines in-person and virtual services to become the new standard of care. This new legislation guarantees that patients with Medicare will continue to benefit from this important innovation in health care delivery.” (Medical Office Manager is offering a webinar on telehealth April 6.  Speaker Jen Bell of Karen Zupko & Associates will present Telehealth:… . . . read more.

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MOM WEBINAR

Learn about changes and updates to telehealth

March 25, 2022 by

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.

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MIPS DEADLINE LOOMS

5 tips for a smoother submission process

March 14, 2022 by

By Jessica Zeff For those of us who have any interactions with the Merit-Based Incentive Program (MIPS), January to March is a particularly busy time of year. Some of us are still working through 2021 documentation audits, checking calculations, collaborating with clinical data registries, and generally working towards making our 2021 MIPS submissions to CMS. At the same time, we’re already submitting data for the 2022 MIPS data collection, applying lessons learned from last year, and planning our MIPS audit strategies for this year. This effort entails understanding changes to the MIPS program and related measures, that is, topped out measures, measures that have changed or been removed, and working with partners to make sure accurate data collection processes are in place. Whoa, that’s quite a lot to cram into… . . . read more.

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AMA SURVEY

Telehealth utilization plateaus but pandemic surges are still a game changer

October 8, 2021 by

Digital technology has laid the groundwork for the long-term shift of medical care from in-person to virtual settings. And while it didn’t start the movement, the COVID-19 pandemic certainly accelerated it. The American Medical Association’s latest Physicians Practice Benchmark Survey offers new insight into the extent and direction of physician practice utilization of telehealth services both before and during the pandemic. Punchline: Between September 2018 and September 2020, telehealth utilization grew from 25 percent to nearly 80 percent. Telehealth Utilization Patterns The AMA’s Division of Economic and Health Policy Research has conducted the Physician Practice Benchmark Survey evaluating physician practice arrangements and payment methodologies for every year since 2012. The analysis draws from the responses of thousands of post-residency physicians who take care of patients for at least 20 hours… . . . read more.

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QPP

First snapshot ready for APM status and data

July 13, 2021 by

The Centers for Medicare & Medicaid Services (CMS) has updated its Quality Payment Program Participation Status Tool based on the first snapshot of Alternative Payment Model (APM) data. The first snapshot, posted July 8,  includes data from Medicare Part B claims with dates of service between Jan. 1, 2021 and March 31, 2021. The tool includes 2021 Qualifying APM Participant (QP) status and Merit-based Incentive Payment System (MIPS) APM participation status. To learn more about how CMS determines QP and the APM participation status for each snapshot, visit the APM Determination webpage on the QPP website. What does QP status mean? If you qualify as a QP, this means you are: Eligible for the 5% APM incentive bonus; Eligible for APM-specific rewards; and Exempt from participating in MIPS. How do I check my QP… . . . read more.

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REIMBURSEMENT

CMS reweighting 2020 MIPS cost performance category

May 20, 2021 by

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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TOOL

HIPAA compliance checklist

May 14, 2021 by

Having a complete HIPAA compliance program is important to your organization. Run through this HIPAA compliance checklist to see if you have your foundation of HIPAA compliance in place and easily retrievable. HIPAA Policies and Procedures HIPAA privacy policies, procedures, and forms HIPAA security policies, procedures, and forms HIPAA Breach Notification policy and procedure Most recent Notice of Privacy practices Privacy officer’s job responsibilities and contact information Security officer’s job responsibilities and contact information HIPAA workflows and evidence of compliance Most recent HIPAA Risk Analysis Most current HIPAA risk mitigation/risk management documentation Business Associate agreements with list of Business Associates Workforce HIPAA training, periodic HIPAA updates, HIPAA training log Password policies by system Workstation security practices (anti-virus, password requirement, password timeframes, workstation use, etc.) HIPAA documentation specific to the organization… . . . read more.

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COMPLIANCE

OIG sounds the warning on improper COVID-19 vaccination billing

May 2, 2021 by

Providers that furnish COVID-19 vaccination and testing services need to look ahead and prepare for the massive federal false billing crackdown that is sure to come if and when the pandemic crisis finally tails off. The latest rumblings from the federal enforcement volcano occurred on April 15 when the OIG issued a relatively rare “Message From HHS-OIG Leadership” (Message) to let it be known that the agencies are hearing reports of false billing and “remain vigilant and committed to holding perpetrators of [COVID-19-related] fraud schemes accountable.” Compliance managers at vaccination facilities are well advised to audit whether their organizations are currently meeting the billing and reimbursement rules the Message summarizes. 6 things to check to ensure proper billing of COVID-19 vaccination The Message specifically reminds providers is being provided by… . . . read more.

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