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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.

CMS

Two new telehealth resources for your practice and your patients

In response to the increased use and expanded coverage of telehealth during the COVID-19 pandemic, From Coverage to Care (C2C) released two new resources to support providers and patients in making the most of virtual care: Telehealth for Providers: What You Need to Know – Providers can learn how and when to use telehealth. Topics include how to set up telehealth services, how to conduct a successful visit, and how to keep up to date on telehealth payment (particularly for Medicare and Medicaid). Telehealth: What to Know for Your Family – Patients can find out the types of care they can receive through telehealth, how to prepare for an appointment, what to expect during a visit, and more. This resource is also available in Spanish. Providers and partners can download graphics to post… . . . read more.

CMS

CMS reopens applications for  COVID-19 MIPS Extreme and Uncontrollable Circumstances Policy 

Centers for Medicare & Medicaid Services continues to offer flexibilities to provide relief to clinicians responding to the 2019 Coronavirus (COVID-19) pandemic. CMS is applying the MIPS automatic extreme and uncontrollable circumstances (EUC) policy to all MIPS eligible clinicians for the 2020 performance period. It is also reopening the MIPS EUC application for individual MIPS eligible clinicians, groups, virtual groups, and Alternative Payment Model (APM) Entities through March 31. Applications received between now and March 31, 2021 won’t override previously submitted data for individuals, groups and virtual groups. This listserv will review what these flexibilities mean for: Individual clinicians, groups, and virtual groups that haven’t submitted data; Individual clinicians, groups, and virtual groups that have submitted data; and APM Entities. Individual clinicians, groups, and virtual groups that haven’t submitted data:… . . . read more.

BILLING & CODING

Updated info for Pfizer-BioNTech vaccine

On Dec. 11, 2020, the U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID‑19 Vaccine for the prevention of COVID-19 for individuals 16 years of age and older. Review Pfizer’s Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers) regarding the limitations of authorized use. During the COVID-19 Public Health Emergency (PHE), Medicare will cover and pay for the administration of the vaccine (when furnished consistent with the EUA). Review the CMS updated payment and HCPCS Level I CPT code structure for specific COVID-19 vaccine information. Only bill for the vaccine administration codes when you submit claims to Medicare; don’t include the vaccine product codes when vaccines are free. Related links: CMS COVID-19 Provider Toolkit CMS COVID-19 FAQs CDC COVID-19 Vaccination Communication Toolkit for medical centers, clinics, and clinicians FDA COVID-19 Vaccines webpage

CMS

Updated 2021 CMS QRDA III Implementation Guide final rule available

The Centers for Medicare & Medicaid Services (CMS) has released an update to the 2021 CMS Quality Reporting Document Architecture (QRDA) Category III Implementation Guide (IG) for Eligible Clinicians and Eligible Professionals to support Calendar Year (CY) 2021 reporting. The update includes the list of electronic clinical quality measures (eCQMs) finalized by CMS for the CY 2021 Performance Period based on the CY 2021 Physician Fee Schedule Final Rule released on Dec. 1, 2020. It also includes information for Improvement Activity Identifiers, Promoting Interoperability Objectives and Measures, and Promoting Interoperability Attestation Statement Identifiers finalized by CMS for the CY 2021 Performance Period based on the CY 2021 Physician Fee Schedule Final Rule. The updated 2021 CMS QRDA III IG outlines requirements for eligible clinicians and eligible professionals to report eCQMs, Improvement Activities, and… . . . read more.

MIPS

Extreme Circumstances Exception application deadline stretched to Feb. 1

To support clinicians during the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) is extending the 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline to Feb. 1, 2021. For the 2020 performance year, CMS will be using its Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency. If your practice has any concerns about the effect of the COVID-19 public health emergency on your performance data, including cost measures, for the 2020 performance period, submit an application now and cite COVID-19 as the reason for your application. If you have an approved application, you can… . . . read more.

Medicare

New deadline of Dec. 13 to update APM Incentive billing info

Is your office among the clinicians that need to verify Medicare billing information by Dec. 13 in order to receive payments? The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program website includes 2020 Alternative Payment Model (APM) Incentive Payment details. To access information on the incentive amount and organization paid, clinicians and surrogates can log in to the QPP website using their HARP credentials. Many eligible clinicians who were Qualifying APM Participants (QPs) based on their 2018 performance began receiving their 2020 5% APM Incentive Payments last month. If you have already received your payment, you do not need to do anything. CMS also posted a new 2020 APM Incentive Payment Fact Sheet to explain: Who is eligible to receive an APM incentive payment in 2020 How CMS determines your 2020 APM… . . . read more.

CMS ANNOUNCES NEW TERMS

You have more time to start COVID-19 Medicare loan repayments

The Centers for Medicare & Medicaid Services (CMS) has announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program.  This Medicare loan program allows CMS to make advance payments to providers and are typically used in emergency situations.  Under the Continuing Appropriations Act, 2021 and Other Extensions Act repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment.  CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden healthcare providers faced while experiencing cash flow issues in the early stages of combating the coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE). “In the throes of an unprecedented pandemic, providers and suppliers on the frontlines needed a lifeline to help keep them… . . . read more.

CODING

Here’s how to represent telehealth encounters in QRDA I Format for eCQMs

The Centers for Medicare & Medicaid Services (CMS) has posted additional guidance for using the Quality Reporting Document Architecture I (QRDA I) format to represent telehealth encounters for the Eligible Professional and Eligible Clinician electronic clinical quality measures (eCQMs) used in CMS quality reporting programs for the 2020 and 2021 performance periods. There is no change to the original guidance provided by CMS in July 2020. Representing Telehealth Encounters in QRDA I format by using the Qualifier attribute: To represent “telehealth-eligible” Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes for eCQMs in QRDA I, submitters should use the optional qualifier attribute of the encounter code element to send the telehealth modifier code in addition to the primary “telehealth-eligible” CPT or HCPCS encounter code from the eCQM-specified value sets. The qualifier attribute name is… . . . read more.

QPP

Deadline Oct. 5 to ask for MIPS targeted review

If you participated in the Merit-based Incentive Payment System (MIPS) in 2019, your performance feedback, including your MIPS final score and payment adjustment factor(s), is now available for review on the Quality Payment Program website. This final score determines the payment adjustment you will receive in 2021, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished by a MIPS eligible clinician in 2021. MIPS eligible clinicians, groups, and virtual groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request the Centers for Medicare & Medicaid Services (CMS) to review the calculation of their 2020 MIPS payment adjustment factor(s) through a process called targeted review. The deadline to submit your request is Oct. 5, 8 p.m…. . . . read more.


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