May 7, 2020

Another Week… Which Means More COVID-19 Reg Changes

In my blog last week, I mentioned that the Centers for Medicare & Medicaid Services (CMS) was planning on releasing a COVID-19 regulation any day—and in fact the reg came out later that same day, Thursday, April 30th.

This is the second major reg CMS has released in response to the COVID-19 pandemic. While the first reg that CMS issued at the end of March had huge implications for emergency physicians, the reg released last Thursday won’t have as much of a direct impact on emergency medicine.

You can read ACEP’s summary of the latest reg here, but of note, CMS made numerous adjustments to the telephone (audio-only) codes (CPT codes 98966-98968 and CPT codes 99441-99443) that CMS had finalized in the last reg. Based on feedback from health care practitioners that many beneficiaries who needed care did not have access to devices that had both an audio and visual component (which is required for telehealth), CMS decided to take the following steps:

  • Increase the value of the telephone codes to match the value of the office and outpatient evaluation and management (E/M) codes; and
  • Waive the current requirement that Medicare telehealth services must be furnished using video technology to allow the telephone (audio-only) codes to temporarily be added to the list of approved Medicare telehealth services.

Thus, health care practitioners are now allowed to bill telephone E/M services instead of office and outpatient E/M codes when appropriate (such as when the Medicare beneficiary does not have access to video technology). When billing these codes, practitioners should follow the same Medicare telehealth rules that CMS had previously established for the pandemic: using the place of service code that would have been used if the service had been provided in person; and attaching modifier 95 to the claim.

Although CMS made these changes to the telephone codes, it’s not likely that you would use them in most circumstances. Emergency physicians in general can and should continue to use the ED E/M codes when providing emergency telehealth services for the duration of the pandemic. Further, once you bill for an ED E/M service, you cannot bill for a follow-up telephone E/M service until seven days after the initial visit.

Beyond the adjustments to the telephone codes, CMS also includes other notable policies in the reg, including:

  • Ensuring that graduate medical education payments to hospitals are not adversely affected because of the response to the COVID-19 pandemic;
  • Modifying calculations and requirements associated with the national accountable care organization (ACO) program, the Medicare Shared Savings Program;
  • Expanding the flexibilities available under the current “primary care exception” to the physician oversight rule;
  • Delaying Qualified Clinical Data Registry (QCDR) testing requirement (ACEP operates an emergency medicine QCDR called the Clinical Emergency Data Registry (CEDR). 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. Click here for more details on MIPS policies.);
  • Allowing a facility under certain, limited circumstances to bill the originating site facility fee for a telehealth service delivered by a health practitioner who ordinarily practices there; and
  • Establishing a separate new E/M code solely to support COVID-19 testing when specimens are collected outside of a laboratory.

Before wrapping up this week’s blog, I would be remiss if I didn’t catch you up this week’s updates to the Provider Relief Fund. There are three notable updates to share.

  1. Last Friday, the Department of Health and Human Services (HHS) started to distribute $12 billion of the provider relief funding to hospitals in areas that have been particularly impacted by COVID-19 and $10 billion to rural health clinics and hospitals. None of this funding was distributed directly to physician groups. For more information about this announcement, please go here.

  2. As described in detail in last week’s blog, there are numerous steps you have to take to receive the second tranche of funding (the additional $20 billion). One of these steps includes attesting to the terms and conditions from the first tranche. This week HHS added language to their attestation portal telling providers to not attest and to contact the HHS hotline (866- 569-3522) if they believe that the payment they received already from the first tranche exceeds their estimated total allocation.

    So what does this mean? As you recall, the first tranche came out to about 6.2 percent of your 2019 Medicare fee-for-service (FFS) payments. The calculation associated with the second tranche, which represents the TOTAL you are to receive from both tranches, comes out to 2 percent of your 2018 gross receipts/sales. Thus, if 6.2 percent of your 2019 Medicare FFS payments exceeds 2 percent of your 2018 gross receipts/sales, you may have received an overpayment and have to contact the HHS hotline. This probably won’t happen to you (your patient mix would have to be heavily skewed towards Medicare FFS), but I wanted to warn you, nonetheless.

  3. You can now start submitting claims for the uninsured program. As I mentioned to you in my last blog, I recommend you review the information in the registration portal, the program’s home page, and frequently asked questions (FAQs). On Monday, the American Hospital Association (AHA) wrote a letter to the Health Resources and Services Administration (the HHS agency administering the program) laying out some important concerns, including about the set of diagnosis codes that must be included on claims in order for them to be reimbursed. We hope that the Health Resources and Services Administration will quickly respond to the AHA’s letter.

I want to end with a request for all my readers. Please continue to keep me apprised of any issues you have experienced trying to receive funding from the Provider Relief Fund. HHS has created a complicated set of processes and terms and conditions, so I want to know what particular challenges you’re facing. Also, as always, please let me know if you have any questions or concerns about the numerous reg changes CMS and other federal agencies are making as we all try to navigate our way through this unprecedented crisis.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!

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