April 30, 2020

CMS Announces Additional Temporary Regulatory Flexibilities

Today, the Centers for Medicare & Medicaid Services (CMS) released an interim final rule (IFR) that establishes new regulatory flexibilities in addition to the policies CMS previously announced at the end of March.

Here are a few of the key policy changes included in the IFR:

  • Graduate Medical Education Payments: To ensure that graduate medical education payments to hospitals are not adversely affected because of the response to the COVID-19 pandemic, CMS will not reduce Medicare payments for teaching hospitals that shift their residents to other hospitals to meet COVID-related needs, or penalize hospitals without teaching programs that accept these residents. This change removes barriers so teaching hospitals can lend available medical staff support to other hospitals.
  • Telephone Codes: CMS is increasing reimbursement of telephone (audio-only) codes to match office/outpatient evaluation and management (E/M) code values. While CMS had already allowed health care professionals to bill for telephone visits during the pandemic, the values of these codes were originally much lower than the values of the office and outpatient E/M codes. Although CMS temporarily adds the telephone codes to the list of approved telehealth services for the duration of the public health emergency, it is important to note that this policy does not impact the emergency department (E/M) codes, which emergency physicians can now use to bill for emergency telehealth services.
  • The Medicare Shared Savings Program: CMS is making numerous changes to the national accountable care organization (ACO) program, the Medicare Shared Savings Program. CMS adjusts the financial methodology for calculating spending in order to account for the pandemic and not penalize ACOs that may have higher costs.  Further, while new ACOs usually come into the program and every year, CMS will not be accepting new applications in 2021.  CMS is also giving ACOs whose participation is set to end this year the option to extend for another year.  Finally, CMS is giving ACOs that were supposed to take on more financial risk next year the opportunity to maintain their current level of risk.
  • Teaching Physician Oversight of Residents: CMS is expanding the flexibilities available under the current “primary care exception” to the physician oversight rules. Specifically, CMS is allowing teaching physicians to not only direct the care furnished by residents, but also to review the services provided with the resident, during or immediately after the visit, remotely via telehealth.
  • Delaying Qualified Clinical Data Registry (QCDR) Testing Requirement: ACEP operates an emergency medicine QCDR called the Clinical Emergency Data Registry (CEDR). CMS is delaying newly-established QCDR testing and data collection requirements by one year. These requirements, which ACEP had expressed concerns about previously, will now not start until 2022. It is important to note that CMS has not yet made any changes to the Merit-based Incentive Payment System (MIPS) requirements for the 2020 performance period. CMS previously changed the deadline for reporting data from the 2019 performance period.  Click here for more details on that MIPS announcement. 
  • Separate Payment for Specimens Collected in a Clinic or Emergency Department Visit: CMS is establishing a separate new E/M code solely to support COVID-19 testing when specimens are collected outside of a laboratory. This code helps to address the address the resource requirements hospitals and clinics face in establishing broad community diagnostic testing for COVID-19, including the significant specimen collection necessary to conduct that testing.


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