On Monday, March 30th, the Centers for Medicare and Medicaid Services (CMS) announced a series of temporary waivers and policy changes for providers in order to improve access to care and mitigate the damage caused by COVID-19 across the country. Click here for the summary of provider changes. Of note to ACG members:
Telehealth: CMS is now allowing the use of telephone E/M services (CPT codes 99441-99443) for Medicare beneficiaries. These services are based on time and were previously non-covered services.
ACG President Mark B. Pochapin, MD, FACG this week urged CMS to extend waiver authority to allow ACG members to us the telephone for traditional E/M services as well. ACG members have voiced their concerns over this policy, as many Medicare beneficiaries are unwilling/unable to use video on cell phone or other devices. This change would also allow Medicare beneficiaries to stay at home.
Changes to MIPS: In addition to extending the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline to April 30, 2020, the MIPS “automatic extreme and uncontrollable circumstances” policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30 deadline.
Important Note for ACG Members
If you are an “MIPS-eligible” clinician and do not submit any MIPS data by April 30, 2020, you won’t need to take any additional action to qualify for this automatic extreme and uncontrollable circumstances exemption. You will be automatically identified and will not receive a cut in Medicare Part B reimbursement 2021 payment year for failing to participate in MIPS (you could receive a cut on certain services for other reasons).
CMS is also reopening the MIPS extreme and uncontrollable circumstances application for individuals, groups, and virtual groups. According to CMS, an application submitted between April 3 and April 30, 2020, citing COVID-19, will override any previous data submission.
Remote Patient Monitoring: Clinicians can provide remote patient monitoring services to both new and established patients. These services can be provided for both acute and chronic conditions and can now be provided for patients with only one disease. (CPT codes 99091, 99457-99458, 9947399474, 99493-99494)
Medicare Beneficiary Consent: CMS now allows “annual consent” to be obtained instead of at the same time each of the services are furnished.
“Stark Law” Waivers: The physician self-referral law (also known as the “Stark Law”—briefly, a physician cannot refer a patient to any entity with which he or she has a financial relationship.) CMS will now permit certain referrals and the submission of related claims that would otherwise violate the Stark Law. CMS cites scenarios such as a physician practice willing to rent or sell needed equipment to a hospital at a price that is below what the practice could charge another party. Or, a hospital may provide space on hospital grounds at no charge to a physician who is willing to treat patients who seek care at the hospital but are not appropriate for emergency department or inpatient care. Hospitals can also provide benefits to their medical staffs, such as multiple daily meals, laundry service to launder soiled personal clothing, or child-care services while the physicians are at the hospital and engaging in activities that benefit the hospital and its patients.
Practitioner Locations: CMS will temporarily waive requirements that physicians and non-physician practitioners be licensed in the state where they are providing services. Please note that state requirements will still apply. CMS waives the Medicare requirement if the following four conditions are met:
- must be enrolled as such in the Medicare program,
- must possess a valid license to practice in the State which relates to his or her Medicare enrollment,
- is furnishing services —whether in person or via telehealth—in a State in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity, and
- is not affirmatively excluded from practice in the State or any other State that is part of the emergency area.
HHS Will Not Enforce HIPAA Rules: This week the U.S. Department of Health and Human Services (HHS) announced, effective immediately, that it will exercise its enforcement discretion and will not impose penalties for violations of certain provisions of the HIPAA Privacy Rule against health care providers or their business associates for the good faith uses and disclosures of protected health information (PHI) by business associates for public health and health oversight activities during the COVID-19 nationwide public health emergency.
According to the HHS fact sheet, this also applies to telehealth services.
ASC Provisions: CMS is relaxing certain conditions of participation (CoPs) for hospital operations. According to CMS, currently enrolled ambulatory surgical centers (ASCs) can temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients. Click here to read more.