Oct 15, 2020 | Uncategorized
CMS announced new recoupment terms that allow providers and suppliers one additional year to start loan payments. For more information on the extended repayment schedule and the new terms continue reading below for more information.nnThe Centers for Medicare & Medicaid Services (CMS) announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program as required by recent action by President Trump and Congress. 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).nn“In the throes of an unprecedented pandemic, providers and suppliers on the frontlines needed a lifeline to help keep them afloat,” said CMS Administrator Seema Verma. “CMS’ advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors. While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal,” she added.nnCMS expanded the AAP Program on March 28, 2020 and gave these loans to healthcare providers and suppliers in order to combat the financial burden of the pandemic. CMS successfully paid more than 22,000 Part A providers, totaling more than $98 billion in accelerated payments. This included payments to Part A providers for Part B items and services they furnished. In addition, more than 28,000 Part B suppliers, including doctors, non-physician practitioners, and Durable Medical Equipment (DME) suppliers, received advance payments totaling more than $8.5 billion.nnProviders were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during this time period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.nnThe letter also provides guidance on how to request an Extended Repayment Schedule (ERS) for providers and suppliers who are experiencing financial hardships. An ERS is a debt installment payment plan that allows a provider or supplier to pay debts over the course of three years, or, up to five years in the case of extreme hardship. Providers and suppliers are encouraged to contact their Medicare Administrative Contractor (MAC) for information on how to request an ERS. To allow even more flexibility in paying back the loans, the $175 billion issued in Provider Relief funds can be used towards repayment of these Medicare loans. CMS will be communicating with each provider and supplier in the coming weeks as to the repayment terms and amounts owed as applicable for any accelerated or advance payment issued.nnOriginal article published on cms.govnn nn
Oct 15, 2020 | Uncategorized
Implantable glucose monitor requests are becoming more frequent from those who have diabetes mellitus. Continue reading below to find out more about the recently updated guidance from Centers for Medicare & Medicaid. nnAs requests for implantable glucose monitors continues to rise among diabetes mellitus (DM) patients, continued guidance from Centers for Medicare & Medicaid Services (CMS) continues.nEffective October 11, 2020, CMS released the newest round of guidance with article A58110 and Local Coverage Determination (LCD) L38617.nThese documentations revealed indications for coverage, limitations, and exceptions.nTherapeutic I-CGMs are considered medically reasonable and necessary by Medicare when all of the following coverage criteria (1-5) are met:n
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- The beneficiary has diabetes mellitus (Refer to the related Billing and Coding Article [A58110] for applicable diagnoses); and,
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- The beneficiary is insulin-treated with multiple (three or more) daily administrations of insulin or a Medicare-covered continuous subcutaneous insulin infusion (CSII) pump; and,
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- The beneficiary’s insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of blood glucose monitor (BGM) or CGM testing results; and,
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- Within six (6) months prior to ordering the I-CGM, the treating practitioner has an in-person visit with the beneficiary to evaluate their diabetes control and determined that criteria (1-3) above are met; and,
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- Routine recommended follow-up care is expected.
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nOriginal article published on cms.gov
Oct 8, 2020 | Uncategorized
nnAs 2021 approaches and new E/M changes are being implemented, it’s time to prepare your practice and sign up for training. Read below for more information on the webinar training from Welter Healthcare Partners. Sign up today with the form on this page to register your practice!nnThe American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) have partnered together to release significant guideline revisions for office and outpatient E/M services effective January 1, 2021. Let WHP’s coding and compliance experts walk you through what you need to know about these important changes, including how to correctly document time-based services versus level of medical decision making and appropriate application of prolonged service codes. nnThis training will compare current and future E/M service guidelines, help you understand how these changes will affect day to day operations, and provide key strategies to prepare. In addition, the training will include interactive exercises, practice scenarios will be evaluated and discussed, and live Q&A will be included. Coding tools will also be provided for reference.nnAt the end of these sessions, attendees will be able to:n
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- Recognize 2021 documentation requirements for EM Services
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- Understand appropriate application of time-based reporting versus level of medical decision making
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- Determine the level of service based on documented details
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- How to appropriately document/capture prolonged services
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- Appreciate the multifactorial impact of well-written note and accurate coding n
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nWebinar Training Dates and Times:n
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- November 18, 2020 12:00pm – 1:30pm MST
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- December 2, 2020 12:00pm – 1:30pm MST
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- December 16, 2020 12:00pm – 1:30pm MST
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nWebinar Cost: nn$149.00 per practice/organizationnnAbout the Presenter: Ginger Avery, CPC, CPMA, CRCnnMs. Avery has over 25 years of experience in the healthcare industry including auditing, abstract coding, coding education and training, regulatory compliance, revenue cycle management, EMR/EHR advisement, reimbursement models, and has been extensively involved in major third-party HCC projects. She is a nationally known speaker and educator with expertise in a wide range of provider specialties and with various organizational types including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). nnAfter obtaining her coding certification (CPC) in 2005, Ms. Avery worked for the medical practice division of a large hospital, and while she specialized in cardiology, she also worked closely with hospitalists and family practice providers. During that time, she also served as a member of the compliance committee and was responsible for writing policies and procedures related to billing, coding and auditing. In 2014, Ginger obtained her Certified Professional Medical Auditor (CPMA) credential and has served the coder-community in many ways including past President and Vice President of her local American Academy of Professional Coders (AAPC) chapter. Ms. Avery’s most recent accomplishment was obtaining AAPC’s Certified Risk Coder (CRC) credential in December 2019. nnAdditional Training Opportunities:nn Welter Healthcare Partners’s Customized Group Training allows study of clinic’s production data, practice scenarios from client’s current medical records and dedicated Q&A time. This customized web-based training runs 2 hours, all staff is encouraged to attend. This option allows the client to set training dates and times. Please contact Jennifer Heuer at jh@rtwelter.com for more information including cost.
Oct 8, 2020 | Uncategorized
The National Committee for Quality Assurance (NCQA), the Alliance for Connected Care, and the American Telemedicine Association (ATA) have assembled the Taskforce on Telehealth Policy to work together to advocate for the healthcare industries continued use of technology in patient care. Read more below!nnOverall, the Taskforce focuses on three main areas: expanding telehealth and its effect on the total cost of care, enhancing patient safety and program integrity in remote care services, and data flow, care integration, and quality measurement.nnThe Taskforce released a proposal on September 15th addressing the retention of telehealth throughout the industry. This proposal sited several areas within the healthcare industry that have seen positive influences on patient care, including skilled nursing facilities and rural areas with geographic restrictions.nnThe full report is available here, along with a webinar recording covering their findings and suggestions.nnClick here to read more from the NCQA
Oct 2, 2020 | Uncategorized
Welter Healthcare Partners is sharing updated information regarding Colorado COVID Telehealth and coding. Read below to find out more about these new CPT codes and new deadlines for Telehealth and benefits.nnClick here for the most recent COVID-19 updates from the Colorado payers. As you can see, most of the commercial payers have extended the deadlines for Telehealth and other expanded benefits through December 31st, 2020. These deadlines are still subject to change and our team will continue to monitor the market for these updates. This update serves as the highlights for each of the payers to keep your team up to date with the notes. The links for the full updates are included on Page 3 for your reference.nnIn addition to these changes with the commercial payers, there are some new CPT codes that have been released in response to the PHE, 99702, and 86413. For quick reference, the long descriptors for these codes are:n
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- 99072 – Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease
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- 86413 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative
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nThe above codes went into effect on 9/8/2020 and it is clear in the CPT assistant information that it is for use once a PHE is declared. Colorado’s PHE was declared 3/13/2020, so it meets that description. While these new codes have been released, effective immediately, we have yet to see the payers adopt these codes and outline expected reimbursement. We suspect it will be based on the calculation of supplies (like 99070) but CMS is currently silent on this topic. You can find additional information included in the link below from AMA with the release notes for these new codes. Our team will continue to monitor the coming changes with these codes to update you accordingly.nn
Oct 2, 2020 | Uncategorized
Just when we thought the past 6 months of 2020 have been hard enough, we now are quickly approaching our annual flu season. According to the CDC, flu season occurs in fall and winter with recommendations for flu shots administration in September and October. Read below to find out more.nnIn the past few years, flu vaccine administration has been increasing among adults 18 and older, and with the added concern and uncertainty of COVID-19, experts are optimistic that this flu season will not only persuade patients who have been hesitant about vaccines but also encourage them to reestablish care with a primary care provider (PCP).nnWith so many national and local pharmacies administering vaccines, clinicians and private practices are being encouraged to ramp up their team for the uncertain road ahead. Start with offering immunizations to your patient populations. Begin a marketing campaign to get the word out about your vaccines. Offer vaccines to your patient’s curbside. And continue to care for patients with telehealth opportunities.nnCMS even has a Flu Vaccine Partner Toolkit that can help you and your practice prepare. Click here to read it!
