2021 News & Updates
December 2021
AHA, AMA and others file lawsuit over No Surprises Act rule that jeopardizes access to care
12/9/2021
American Hospital Association
The AHA and American Medical Association today sued the federal government over the misguided implementation of the federal surprise billing law. The associations are joined in the suit by hospital and physician plaintiffs, including Renown Health, UMass Memorial Health and two physicians based in North Carolina. Click here to read the full press release from the AHA.
12/9/2021
American Hospital Association
The AHA and American Medical Association today sued the federal government over the misguided implementation of the federal surprise billing law. The associations are joined in the suit by hospital and physician plaintiffs, including Renown Health, UMass Memorial Health and two physicians based in North Carolina. Click here to read the full press release from the AHA.
CMS Hosts Special Open Door Forum on No Surprises Act Provider Requirements
12/8/2021
CMS
The Centers for Medicare & Medicaid Services hosted a Special Open Door Forum on December 8, 2021, to explain provider requirements under the No Surprises Act. Starting January 1, 2022, consumers will have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. These requirements generally apply to items and services provided to people enrolled in group health plans, group or individual health insurance coverage, Federal Employees Health Benefits plans, and the uninsured.
Resources:
12/8/2021
CMS
The Centers for Medicare & Medicaid Services hosted a Special Open Door Forum on December 8, 2021, to explain provider requirements under the No Surprises Act. Starting January 1, 2022, consumers will have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. These requirements generally apply to items and services provided to people enrolled in group health plans, group or individual health insurance coverage, Federal Employees Health Benefits plans, and the uninsured.
Resources:
- Click here to view presentation slides.
- Access the Provider Requirements and Resources webpage
- Have questions? Email provider_enforcement@cms.hhs.gov
AAOS Letter of Feedback to CMS on Surprise Billing; Part II Interim Final Rule
12/7/2021
AAOS
In its formal comments to regulators on the process for resolving out-of-network medical billing disputes, the American Association of Orthopaedic Surgeons (AAOS) strongly urged the Departments of Health and Human Services, Labor, and Treasury, as well as the Office of Personnel Management to revise the regulations to be more closely aligned with the No Surprises Act.
Click here to read the full statement from the AAOS.
Click here to read the full letter from the AAOS to regulators.
12/7/2021
AAOS
In its formal comments to regulators on the process for resolving out-of-network medical billing disputes, the American Association of Orthopaedic Surgeons (AAOS) strongly urged the Departments of Health and Human Services, Labor, and Treasury, as well as the Office of Personnel Management to revise the regulations to be more closely aligned with the No Surprises Act.
Click here to read the full statement from the AAOS.
Click here to read the full letter from the AAOS to regulators.
November 2021
CMS to Apply MIPS Automatic Extreme & Uncontrollable Circumstances Policy for 2021 Performance Year
11/11/2021
CMS
The following message is from the Centers for Medicare & Medicaid Services:
The Centers for Medicare & Medicaid Services (CMS) continues to provide relief where possible to clinicians responding to the 2019 Coronavirus (COVID-19) public health emergency (PHE). We’re applying the Merit-based Incentive Payment System (MIPS) automatic extreme and uncontrollable circumstances (EUC) policy to ALL individually eligible MIPS eligible clinicians for the 2021 performance year (PY). Please note that this announcement is for PY2021 only.
The automatic EUC policy only applies to MIPS eligible clinicians who are eligible to participate in MIPS as individuals. The automatic EUC policy doesn’t apply to groups, virtual groups, or Alternative Payment Model (APM) Entities.
MIPS eligible clinicians who are eligible to participate in MIPS as individuals
You don’t need to take any action to have the automatic EUC policy applied to you. You’ll be automatically identified and will have all 4 MIPS performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless you 1) submit data in 2 or more performance categories, or 2) have a higher final score from group or APM Entity participation.
Small practices reporting Medicare Part B claims measures
Under current policies, we automatically calculate a quality score from Medicare Part B claims measures at the individual and group level.
The automatic EUC policy doesn’t apply to groups. You don’t need to take any further action if you’re not able to submit data for the 2021 performance year. Group participation is optional (specific guidance for small practices noted above), and your individually eligible MIPS eligible clinicians qualify for the automatic EUC policy if you don’t report at the group-level on their behalf. (If you submit data at the group level on behalf of your MIPS eligible clinicians, the group will receive a MIPS final score based on the data submitted.) Your MIPS eligible clinicians will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless 1) they submit data in 2 or more performance categories, or 2) they have a higher final score from group or APM Entity participation.
Virtual Groups
MIPS eligible clinicians in a virtual group will receive a payment adjustment based on the virtual group’s final score, even if no data is submitted. (When no data is submitted for the virtual group, the MIPS eligible clinicians in the virtual group could receive the maximum negative payment adjustment of -9% in the 2023 payment year.)
The automatic EUC policy doesn’t apply to APM Entities. You don’t need to take any action if you’re not able to submit data for the 2021 performance year. APM Entity participation is optional (specific guidance for small practices noted above), and your individually eligible MIPS eligible clinicians will have the automatic EUC policy applied to them if you don’t report at the APM-Entity level on their behalf. (If you submit data at the APM-Entity level on behalf of your MIPS eligible clinicians, the APM Entity will receive a MIPS final score based on data submitted.) Your MIPS eligible clinicians will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless 1) they submit data in 2 or more performance categories, or 2) they have a higher final score from group or APM Entity participation.
If your APM Entity would like to request performance category reweighting for the 2021 performance year, you must submit an EUC application.
The MIPS Automatic EUC policy doesn’t apply to Shared Savings Program Accountable Care Organizations (ACOs). ACOs can submit a PY2021 EUC Exception Application on behalf of its MIPS eligible clinicians if they are unable to report via the Alternative Payment Model (APM) Performance Pathway (APP). To submit a PY2021 EUC Exception Application, ACOs must demonstrate that greater than 75% of its MIPS eligible clinicians would be eligible for reweighting the Promoting Interoperability performance category. ACOs can submit PY2021 EUC Exception Applications by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation through December 31, 2021.
Note: The Shared Savings Program Quality EUC policy for determining shared savings and losses applies to all Shared Savings Program ACOs for performance year 2021. CMS considers all ACOs to be affected by the COVID-19 PHE and the Shared Savings Program EUC policy applies for PY2021. ACOs that are able to report quality data via the APP and meet MIPS data completeness and case minimum requirements will receive the higher of their ACO quality score or the 30th percentile MIPS quality performance category score. ACOs that are unable to report quality data via the APP and meet the MIPS quality data completeness and case minimum requirements, will have their quality score set equal to the 30th percentile MIPS quality performance category score.
Additional Resources
Disclaimer: The contents of this listserv do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract. This listserv is intended only to provide clarity to the public regarding existing policies under the law.
11/11/2021
CMS
The following message is from the Centers for Medicare & Medicaid Services:
The Centers for Medicare & Medicaid Services (CMS) continues to provide relief where possible to clinicians responding to the 2019 Coronavirus (COVID-19) public health emergency (PHE). We’re applying the Merit-based Incentive Payment System (MIPS) automatic extreme and uncontrollable circumstances (EUC) policy to ALL individually eligible MIPS eligible clinicians for the 2021 performance year (PY). Please note that this announcement is for PY2021 only.
The automatic EUC policy only applies to MIPS eligible clinicians who are eligible to participate in MIPS as individuals. The automatic EUC policy doesn’t apply to groups, virtual groups, or Alternative Payment Model (APM) Entities.
MIPS eligible clinicians who are eligible to participate in MIPS as individuals
You don’t need to take any action to have the automatic EUC policy applied to you. You’ll be automatically identified and will have all 4 MIPS performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless you 1) submit data in 2 or more performance categories, or 2) have a higher final score from group or APM Entity participation.
Small practices reporting Medicare Part B claims measures
Under current policies, we automatically calculate a quality score from Medicare Part B claims measures at the individual and group level.
- Clinicians in small practices that report Medicare Part B claims measures who are only eligible to participate in MIPS as part of a group aren’t covered by the automatic EUC policy and will receive the group’s final score. (To identify these clinicians, sign in to qpp.cms.gov, navigate to the “Eligibility & Reporting” page and click “View Clinician Eligibility”. Clinicians who are only eligible to participate as part of a group will have a green check mark next to “Group”; there won’t be a green check mark next to “Individual”.)
- Some small practices may not be aware of the implications of their PY 2021 claims reporting due to some of the policies we introduced at the onset of the COVID-19 PHE.
- As a result, these small practices may wish to request performance category reweighting on behalf of the group through the PY2021 EUC Exception Application, citing COVID-19 as the triggering event.
- PY2021 EUC Exception Applications can be submitted by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation.
The automatic EUC policy doesn’t apply to groups. You don’t need to take any further action if you’re not able to submit data for the 2021 performance year. Group participation is optional (specific guidance for small practices noted above), and your individually eligible MIPS eligible clinicians qualify for the automatic EUC policy if you don’t report at the group-level on their behalf. (If you submit data at the group level on behalf of your MIPS eligible clinicians, the group will receive a MIPS final score based on the data submitted.) Your MIPS eligible clinicians will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless 1) they submit data in 2 or more performance categories, or 2) they have a higher final score from group or APM Entity participation.
Virtual Groups
MIPS eligible clinicians in a virtual group will receive a payment adjustment based on the virtual group’s final score, even if no data is submitted. (When no data is submitted for the virtual group, the MIPS eligible clinicians in the virtual group could receive the maximum negative payment adjustment of -9% in the 2023 payment year.)
- If you’re unable to submit data for the 2021 performance year as a result of the ongoing COVID-19 PHE, you can submit a PY2021 EUC Exception Application on behalf of the virtual group, citing COVID-19, to request reweighting for all 4 performance categories.
- PY2021 EUC Exception Applications can be submitted by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation through December 31, 2021.
The automatic EUC policy doesn’t apply to APM Entities. You don’t need to take any action if you’re not able to submit data for the 2021 performance year. APM Entity participation is optional (specific guidance for small practices noted above), and your individually eligible MIPS eligible clinicians will have the automatic EUC policy applied to them if you don’t report at the APM-Entity level on their behalf. (If you submit data at the APM-Entity level on behalf of your MIPS eligible clinicians, the APM Entity will receive a MIPS final score based on data submitted.) Your MIPS eligible clinicians will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless 1) they submit data in 2 or more performance categories, or 2) they have a higher final score from group or APM Entity participation.
If your APM Entity would like to request performance category reweighting for the 2021 performance year, you must submit an EUC application.
- PY2021 EUC Exception Applications can be submitted by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation through December 31, 2021.
The MIPS Automatic EUC policy doesn’t apply to Shared Savings Program Accountable Care Organizations (ACOs). ACOs can submit a PY2021 EUC Exception Application on behalf of its MIPS eligible clinicians if they are unable to report via the Alternative Payment Model (APM) Performance Pathway (APP). To submit a PY2021 EUC Exception Application, ACOs must demonstrate that greater than 75% of its MIPS eligible clinicians would be eligible for reweighting the Promoting Interoperability performance category. ACOs can submit PY2021 EUC Exception Applications by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation through December 31, 2021.
Note: The Shared Savings Program Quality EUC policy for determining shared savings and losses applies to all Shared Savings Program ACOs for performance year 2021. CMS considers all ACOs to be affected by the COVID-19 PHE and the Shared Savings Program EUC policy applies for PY2021. ACOs that are able to report quality data via the APP and meet MIPS data completeness and case minimum requirements will receive the higher of their ACO quality score or the 30th percentile MIPS quality performance category score. ACOs that are unable to report quality data via the APP and meet the MIPS quality data completeness and case minimum requirements, will have their quality score set equal to the 30th percentile MIPS quality performance category score.
Additional Resources
- 2021 MIPS Extreme and Uncontrollable Circumstances Application Guide
- Quality Payment Program COVID-19 Response Fact Sheet
Disclaimer: The contents of this listserv do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract. This listserv is intended only to provide clarity to the public regarding existing policies under the law.
COVID-19 Health Care Staff Vaccination IFC-6: Presentation Slides & Video
11/8/2021
CMS
On November 7, CMS hosted a stakeholder call regarding the COVID-19 Omnibus Vaccine Rule (IFC-6).
CMS has posted the presentation slides and a recording of the stakeholder call for your convenience.
To view the slides, click here. To view the video, click here.
In addition to the resources above, CMS has prepared a frequently asked questions document, available here.
The next stakeholder call will be held on: Wednesday, November 10 from 3:30 – 4:30 pm EST. To register in advance, click here.
After registering, you will receive a confirmation email containing information about joining the webinar. Please note: they can only accommodate 10,000 participants so register early to guarantee your participation.
11/8/2021
CMS
On November 7, CMS hosted a stakeholder call regarding the COVID-19 Omnibus Vaccine Rule (IFC-6).
CMS has posted the presentation slides and a recording of the stakeholder call for your convenience.
To view the slides, click here. To view the video, click here.
In addition to the resources above, CMS has prepared a frequently asked questions document, available here.
The next stakeholder call will be held on: Wednesday, November 10 from 3:30 – 4:30 pm EST. To register in advance, click here.
After registering, you will receive a confirmation email containing information about joining the webinar. Please note: they can only accommodate 10,000 participants so register early to guarantee your participation.
October 2021
AAOS Action Alert: Demand Correct Implementation of the No Surprises Act
10/21/2021
AAOS
In late 2020, Congress passed the No Surprises Act which aimed to fix the problem of unanticipated medical bills. In its attempt to implement the law and IDR process, the Administration crafted rules that disregard congressional intent and are inconsistent with the carefully negotiated statutory language. Even worse, they give priority to the insurer-formulated median in-network rate over all other factors which may lead to sweeping reductions in both out-of-network and in-network reimbursement over time.
Please join AAOS in demanding that the Administration correctly implement the No Surprises Act. Ask your representatives to sign onto the congressional letter being led by U.S. Representatives Tom Suozzi (D-NY) and Brad Wenstrup (R-OH) before the Oct. 29 deadline. Click here to read more.
10/21/2021
AAOS
In late 2020, Congress passed the No Surprises Act which aimed to fix the problem of unanticipated medical bills. In its attempt to implement the law and IDR process, the Administration crafted rules that disregard congressional intent and are inconsistent with the carefully negotiated statutory language. Even worse, they give priority to the insurer-formulated median in-network rate over all other factors which may lead to sweeping reductions in both out-of-network and in-network reimbursement over time.
Please join AAOS in demanding that the Administration correctly implement the No Surprises Act. Ask your representatives to sign onto the congressional letter being led by U.S. Representatives Tom Suozzi (D-NY) and Brad Wenstrup (R-OH) before the Oct. 29 deadline. Click here to read more.
September 2021
Biden-Harris Administration Advances Key Protections Against Surprise Medical Bills
9/30/2021
CMS
Today, the Biden-Harris Administration, through the Departments of Health and Human Services (HHS), Labor (DOL), Treasury (collectively, the Departments), and the Office of Personnel Management (OPM) issued an interim final rule with comment period to further implement the No Surprises Act – a consumer protection law that helps curb the practice of surprise medical billing.
This rule details a process that will take patients out of the middle of payment disputes, provides a transparent process to settle out-of-network (OON) rates between providers and payers, and outlines requirements for health care cost estimates for uninsured (or self-pay) individuals. Click here to read more.
9/30/2021
CMS
Today, the Biden-Harris Administration, through the Departments of Health and Human Services (HHS), Labor (DOL), Treasury (collectively, the Departments), and the Office of Personnel Management (OPM) issued an interim final rule with comment period to further implement the No Surprises Act – a consumer protection law that helps curb the practice of surprise medical billing.
This rule details a process that will take patients out of the middle of payment disputes, provides a transparent process to settle out-of-network (OON) rates between providers and payers, and outlines requirements for health care cost estimates for uninsured (or self-pay) individuals. Click here to read more.
AAOS Comments on Proposed Medicare Payment Policy Changes for 2022
9/24/2021
AAOS
AAOS recently issued formal comments to the Centers for Medicare & Medicaid Services on the agency’s proposed payment policy changes for Calendar Year (CY) 2022, including changes to the Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS/ASC) payment systems and the Physician Fee Schedule (PFS). The Associations' comments addressed significant proposed changes that would impact musculoskeletal care, including abruptly reversing elimination of the Inpatient Only List (pulling back the 298 procedures, including 266 musculoskeletal procedures, that were removed from the list on Jan. 1), reducing the conversion factor by a proposed 3.75 percent, and failing to incorporate office/outpatient evaluation and management code updates into the global surgical codes.
Click here to read the press release.
9/24/2021
AAOS
AAOS recently issued formal comments to the Centers for Medicare & Medicaid Services on the agency’s proposed payment policy changes for Calendar Year (CY) 2022, including changes to the Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS/ASC) payment systems and the Physician Fee Schedule (PFS). The Associations' comments addressed significant proposed changes that would impact musculoskeletal care, including abruptly reversing elimination of the Inpatient Only List (pulling back the 298 procedures, including 266 musculoskeletal procedures, that were removed from the list on Jan. 1), reducing the conversion factor by a proposed 3.75 percent, and failing to incorporate office/outpatient evaluation and management code updates into the global surgical codes.
Click here to read the press release.
New Report on Uptick in Telehealth Use During the Pandemic
9/21/2021
The American Medical Association (AMA)
A report based on the AMA’s Physician Practice Benchmark Survey describes the rapid uptick in physicians’ use of telehealth between Sept. 2018 and Sept. 2020. Over that period, the share of physicians in practices that used videoconferencing to provide patient visits increased from 14.3% to 70.3%. The report also shows that telehealth was used to treat a diverse set of patients with a variety of needs.
9/21/2021
The American Medical Association (AMA)
A report based on the AMA’s Physician Practice Benchmark Survey describes the rapid uptick in physicians’ use of telehealth between Sept. 2018 and Sept. 2020. Over that period, the share of physicians in practices that used videoconferencing to provide patient visits increased from 14.3% to 70.3%. The report also shows that telehealth was used to treat a diverse set of patients with a variety of needs.
New physician “gold card” law will cut prior authorization delays
9/15/2021
The American Medical Association (AMA), Andis Robeznieks
A gold card carries with it a certain status. For credit card holders, it implies that they are reliable borrowers who pay their bills on time. For Texas physicians, the gold card indicates they consistently meet prior authorization requirements and that state-regulated insurance companies will not delay their patients’ care.
Click here to read the article from the AMA.
9/15/2021
The American Medical Association (AMA), Andis Robeznieks
A gold card carries with it a certain status. For credit card holders, it implies that they are reliable borrowers who pay their bills on time. For Texas physicians, the gold card indicates they consistently meet prior authorization requirements and that state-regulated insurance companies will not delay their patients’ care.
Click here to read the article from the AMA.
AMA Shares Comments & Concerns on Surprise Billing Requirements
9/7/2021
The American Medical Association (AMA)
The American Medical Association (AMA) recently submitted a comment letter to Centers for Medicare & Medicaid Services (CMS) on the Interim Final Rule: Requirements Related to Surprise Billing; Part I.
Click here to read the letter.
9/7/2021
The American Medical Association (AMA)
The American Medical Association (AMA) recently submitted a comment letter to Centers for Medicare & Medicaid Services (CMS) on the Interim Final Rule: Requirements Related to Surprise Billing; Part I.
Click here to read the letter.
August 2021
2020 MIPS Performance Feedback, Final Score, and 2022 MIPS Payment Adjustment Information
8/18/2021
The Centers for Medicare & Medicare Services (CMS)
The Centers for Medicare & Medicare Services (CMS) will be updating the Merit-based Incentive Payment System (MIPS) performance feedback and final scores for some clinicians for performance year 2020 and the associated MIPS payment adjustment information for payment year 2022. You can view your current MIPS performance feedback, final score, and payment adjustment on the Quality Payment Program website. Please note the information you see now may be changing.
To learn more about the information in your performance feedback, review the following 2020 MIPS Performance Feedback Resources:
8/18/2021
The Centers for Medicare & Medicare Services (CMS)
The Centers for Medicare & Medicare Services (CMS) will be updating the Merit-based Incentive Payment System (MIPS) performance feedback and final scores for some clinicians for performance year 2020 and the associated MIPS payment adjustment information for payment year 2022. You can view your current MIPS performance feedback, final score, and payment adjustment on the Quality Payment Program website. Please note the information you see now may be changing.
To learn more about the information in your performance feedback, review the following 2020 MIPS Performance Feedback Resources:
- NEW! 2020 Performance Period Benchmarks (ZIP) – Identifies the performance period benchmark results (as available) for measures without a historical benchmark and provides general information about performance period benchmarks.
- 2020 MIPS Performance Feedback FAQs (PDF) – Highlights what performance feedback is, who receives the feedback, and how to access it on the Quality Payment Program website.
- 2022 MIPS Payment Year Payment Adjustment User Guide (PDF) – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions.
July 2021
Telehealth Flexibilities are Extended Again
7/20/2021
KarenZupko & Associates, Inc
Secretary Becerra of Health and Human Services once again renewed the ongoing COVID-19 public health emergency (PHE) yesterday, July 19, 2021. Although the PHE will most likely remain in place through the end of the year, extensions must be revisited every 90 days. The current extension end date is through Monday, October 18, 2021.
For more information regarding this and other topics pertaining to telehealth and COVID-19, visit http://www.karenzupko.com/KZA-telehealth-solution-center.
7/20/2021
KarenZupko & Associates, Inc
Secretary Becerra of Health and Human Services once again renewed the ongoing COVID-19 public health emergency (PHE) yesterday, July 19, 2021. Although the PHE will most likely remain in place through the end of the year, extensions must be revisited every 90 days. The current extension end date is through Monday, October 18, 2021.
For more information regarding this and other topics pertaining to telehealth and COVID-19, visit http://www.karenzupko.com/KZA-telehealth-solution-center.
June 2021
Site-neutral payments: The Supreme Court weighs in
6/30/2021
By Laura Dyrda, Becker's ASC Review
The American Hospital Association and other hospitals have spent the last few years disputing the CMS decision to expand its site-neutral pay policy. Now the Supreme Court has weighed in.
The highest court in the nation decided June 28 not to hear the association's appeal of a change of the 2019 Outpatient Prospective Payment System Rule that reduced the pay rate for services provided at off-campus provider-based departments and clinics, upholding the policy. While the association has decried the payment decision since it was proposed, ASC executives have lauded efforts by HHS and CMS to level the playing field with site-neutral payments.
Continue reading
6/30/2021
By Laura Dyrda, Becker's ASC Review
The American Hospital Association and other hospitals have spent the last few years disputing the CMS decision to expand its site-neutral pay policy. Now the Supreme Court has weighed in.
The highest court in the nation decided June 28 not to hear the association's appeal of a change of the 2019 Outpatient Prospective Payment System Rule that reduced the pay rate for services provided at off-campus provider-based departments and clinics, upholding the policy. While the association has decried the payment decision since it was proposed, ASC executives have lauded efforts by HHS and CMS to level the playing field with site-neutral payments.
Continue reading
OSHA announces new COVID-19 safety rule for health care industry
6/14/2021
On June 10, 2021, OSHA announced a new Emergency Temporary Standard for the Health Care Industry. According to the fact sheet released by the Labor Department:
"The ETS is effective immediately upon publication in the Federal Register. Employers must comply with most provisions within 14 days, and with provisions involving physical barriers, ventilation, and training within 30 days. OSHA will use its enforcement discretion for employers who are making a good faith effort to comply with the ETS. OSHA will continue to monitor trends in COVID-19 infections and deaths as more of the workforce and the general population become vaccinated and the pandemic continues to evolve. Where OSHA finds a grave danger from the virus no longer exists for the covered workforce (or some portion thereof), or new information indicates a change in measures necessary to address the grave danger, OSHA will update the ETS, as appropriate."
Resources:
Homepage for OSHA Emergency Temporary Standard for the Health Care Industry: https://www.osha.gov/coronavirus/ets
Summary/Fact Sheet of Temporary Standards: https://www.osha.gov/sites/default/files/publications/OSHA4122.pdf
Full PDF of the new requirements: https://www.osha.gov/sites/default/files/covid-19-healthcare-ets-reg-text.pdf
6/14/2021
On June 10, 2021, OSHA announced a new Emergency Temporary Standard for the Health Care Industry. According to the fact sheet released by the Labor Department:
"The ETS is effective immediately upon publication in the Federal Register. Employers must comply with most provisions within 14 days, and with provisions involving physical barriers, ventilation, and training within 30 days. OSHA will use its enforcement discretion for employers who are making a good faith effort to comply with the ETS. OSHA will continue to monitor trends in COVID-19 infections and deaths as more of the workforce and the general population become vaccinated and the pandemic continues to evolve. Where OSHA finds a grave danger from the virus no longer exists for the covered workforce (or some portion thereof), or new information indicates a change in measures necessary to address the grave danger, OSHA will update the ETS, as appropriate."
Resources:
Homepage for OSHA Emergency Temporary Standard for the Health Care Industry: https://www.osha.gov/coronavirus/ets
Summary/Fact Sheet of Temporary Standards: https://www.osha.gov/sites/default/files/publications/OSHA4122.pdf
Full PDF of the new requirements: https://www.osha.gov/sites/default/files/covid-19-healthcare-ets-reg-text.pdf
May 2021
CMS Announcement on MIPS Cost Category
5/24/2021
On May 20, 2021, the Centers for Medicare & Medicaid Services (CMS) announced that the 2020 MIPS Cost Performance Category will be reweighted to 0% of the final score even if eligible physicians or groups submitted 2020 data in other MIPS categories in light of the impact of the COVID-19 pandemic. For over a year, the AMA has been recommending that CMS zero out this category during the pandemic for several reasons, including concerns that decreases in patient visits and increases in the costs of caring for patients with COVID-19 could unfairly penalize physicians. We applaud CMS for holding physicians harmless from unfair evaluations in the MIPS Cost Performance Category as a result of the COVID-19 pandemic.
The AMA also strongly supports CMS’ decision to release the 2018 and 2019 cost measure benchmark files, which we will review closely to identify the target spending for those years, how the benchmarks capture any variations in spending, and whether the benchmarks are leading to fair and valid comparisons among physicians. Again, the AMA has been recommending to CMS for a while that the agency should publish the data. In April, the AMA and 47 national medical specialty societies sent a letter urging CMS to immediately release the MIPS cost benchmarks to increase transparency in how the agency evaluates physician performance in the Cost Performance Category in MIPS and to allow physicians and other stakeholders to assess the measures for validity and opportunities to reduce spending. We anticipate this information will be informative for specialty societies that are engaged in the ongoing development of new episode-based cost measures and MIPS Value Pathways (MVPs).
Source: AMA
5/24/2021
On May 20, 2021, the Centers for Medicare & Medicaid Services (CMS) announced that the 2020 MIPS Cost Performance Category will be reweighted to 0% of the final score even if eligible physicians or groups submitted 2020 data in other MIPS categories in light of the impact of the COVID-19 pandemic. For over a year, the AMA has been recommending that CMS zero out this category during the pandemic for several reasons, including concerns that decreases in patient visits and increases in the costs of caring for patients with COVID-19 could unfairly penalize physicians. We applaud CMS for holding physicians harmless from unfair evaluations in the MIPS Cost Performance Category as a result of the COVID-19 pandemic.
The AMA also strongly supports CMS’ decision to release the 2018 and 2019 cost measure benchmark files, which we will review closely to identify the target spending for those years, how the benchmarks capture any variations in spending, and whether the benchmarks are leading to fair and valid comparisons among physicians. Again, the AMA has been recommending to CMS for a while that the agency should publish the data. In April, the AMA and 47 national medical specialty societies sent a letter urging CMS to immediately release the MIPS cost benchmarks to increase transparency in how the agency evaluates physician performance in the Cost Performance Category in MIPS and to allow physicians and other stakeholders to assess the measures for validity and opportunities to reduce spending. We anticipate this information will be informative for specialty societies that are engaged in the ongoing development of new episode-based cost measures and MIPS Value Pathways (MVPs).
Source: AMA
Medicare begins automatic recoupment of COVID-19 Accelerated and Advance Payments
5/6/2021
The Centers for Medicare and Medicaid Services (CMS) recently began automatic recoupment of COVID-19 Accelerated and Advance Payments, which were an advance of up to three months of Medicare payments to help physician practices keep the lights on early in the COVID-19 pandemic. The American Medical Association(AMA) and the Federation strongly advocated for improved repayment terms, which Congress and CMS adopted in 2020. Under the revised repayment terms, physicians should be aware that:
Source: AMA
5/6/2021
The Centers for Medicare and Medicaid Services (CMS) recently began automatic recoupment of COVID-19 Accelerated and Advance Payments, which were an advance of up to three months of Medicare payments to help physician practices keep the lights on early in the COVID-19 pandemic. The American Medical Association(AMA) and the Federation strongly advocated for improved repayment terms, which Congress and CMS adopted in 2020. Under the revised repayment terms, physicians should be aware that:
- These funds are loans that are required to be repaid.
- Repayment begins one year from when the Medicare advance payment is received, rather than 120 days under the original terms.
- The per claim recoupment amount was reduced from 100% to 25% for the first 11 months, and then 50% for an additional six months.
- If there is an outstanding balance after the 17-month recoupment time frame, the Medicare Administrative Contractor (MAC) will issue a demand letter requiring repayment subject to an interest rate of 4%, a decrease from the original interest rate of 10.25%.
- Physicians may repay the Medicare advance payment in full at any time by contacting their MAC.
Source: AMA
April 2021
New York BCBS policy change drives surgery to ASCs
Empire BlueCross BlueShield in New York updated its coverage policy this year to drive more surgical procedures to ASCs.
The policy was published Oct. 1 and went into effect Jan. 1. Empire commercial plan members now need a medical necessity review to have certain procedures performed in the outpatient hospital setting instead of an ASC.
"Empire BlueCross BlueShield is committed to being a valued healthcare partner in identifying ways to achieve better outcomes, lower costs and deliver access to a better healthcare experience for consumers," the payer wrote in the Oct. 1 announcement of its policy change.
The site of care review applies to a 33-page list of procedures, including gastroenterology, orthopedics, ophthalmology, auditory and nervous system procedures. There are 111 musculoskeletal procedures on the list, in addition to common procedures such as cataract surgery and colonoscopy.
Only procedures performed in the hospital outpatient setting are subject to the review; ASCs are not. The overall cost of care is typically lower for surgery centers than in hospital outpatient departments, and the move could be a boon for New York ASCs.
Read more: https://www.beckersasc.com/asc-coding-billing-and-collections/new-york-bcbs-policy-change-drives-surgery-to-ascs.html
Empire BlueCross BlueShield in New York updated its coverage policy this year to drive more surgical procedures to ASCs.
The policy was published Oct. 1 and went into effect Jan. 1. Empire commercial plan members now need a medical necessity review to have certain procedures performed in the outpatient hospital setting instead of an ASC.
"Empire BlueCross BlueShield is committed to being a valued healthcare partner in identifying ways to achieve better outcomes, lower costs and deliver access to a better healthcare experience for consumers," the payer wrote in the Oct. 1 announcement of its policy change.
The site of care review applies to a 33-page list of procedures, including gastroenterology, orthopedics, ophthalmology, auditory and nervous system procedures. There are 111 musculoskeletal procedures on the list, in addition to common procedures such as cataract surgery and colonoscopy.
Only procedures performed in the hospital outpatient setting are subject to the review; ASCs are not. The overall cost of care is typically lower for surgery centers than in hospital outpatient departments, and the move could be a boon for New York ASCs.
Read more: https://www.beckersasc.com/asc-coding-billing-and-collections/new-york-bcbs-policy-change-drives-surgery-to-ascs.html
RevCycle Intelligence (4/5, LaPointe) reports, “CMS has started recouping Medicare payments it fronted to [health care] providers last year during the COVID-19 pandemic.” CMS “stated that it has begun recovering the payments through the COVID-19 Accelerated and Advance Payments (CAAP) on March 30, 2021, and will continue recoupment depending on the one year anniversary of when providers received their first payment.”
February 2021
Will more payers buy ASCs? By Laura Dyrda - Becker's ASC Review
ASC industry leaders expect more consolidation in the coming years as the cost and risk of owning independent centers increases. How often will the buyer be a payer? Naya Kehayes, principal at ECG Management Consultants, expects more payer investments in the future. Payers with ownership in ASCs have access to the center's data and can directly funnel patients into the surgery center.
"Optum, a part of the UnitedHealth Group, owns SCA. Kaiser definitely has ownership in surgery centers, and there are other payers across the country that maintain ownership in surgery centers," she said during a session at the Becker's ASC Virtual Event in October 2020. "You're going to see more payers taking equity in a lower-cost delivery platform, because it creates alignment to reduce costs and influence further migration."
Optum acquired Surgical Care Affiliates in 2017 for $2.3 billion. At the time, SCA owned or operated 205 surgical facilities in partnership with about 3,000 physicians. Since then, the company has grown to operate more than 230 surgical facilities, and it added 1,000 more physicians to its network last year. The company also added more than 40 new service lines in 2020, doubling the number added in 2019. Read more
ASC industry leaders expect more consolidation in the coming years as the cost and risk of owning independent centers increases. How often will the buyer be a payer? Naya Kehayes, principal at ECG Management Consultants, expects more payer investments in the future. Payers with ownership in ASCs have access to the center's data and can directly funnel patients into the surgery center.
"Optum, a part of the UnitedHealth Group, owns SCA. Kaiser definitely has ownership in surgery centers, and there are other payers across the country that maintain ownership in surgery centers," she said during a session at the Becker's ASC Virtual Event in October 2020. "You're going to see more payers taking equity in a lower-cost delivery platform, because it creates alignment to reduce costs and influence further migration."
Optum acquired Surgical Care Affiliates in 2017 for $2.3 billion. At the time, SCA owned or operated 205 surgical facilities in partnership with about 3,000 physicians. Since then, the company has grown to operate more than 230 surgical facilities, and it added 1,000 more physicians to its network last year. The company also added more than 40 new service lines in 2020, doubling the number added in 2019. Read more
American Medical Association Guide to Surprise Billing Law
Click here for an initial guide to the major provisions in the “No Surprises Act,” the surprise billing legislation that was included in the Consolidated Appropriations Act COVID-19 relief bill signed into law on December 27, 2020. The No Surprises Act allows for price transparency, provider directories, and patient financial protections that impact health plans, physicians, facilities, and other non-MD/DO licensed health care professionals. The law goes into effect on January 1, 2022. The intent of the law is not to preempt state surprise billing laws. However, there is some ambiguity in the statutory language that will require further clarification before and during the rulemaking process, including when the surprise billing protections apply to patients in self-funded ERISA plans. The AMA will work with Federation members and other stakeholders to seek clarification to address these ambiguities and will revise this guide accordingly as new information becomes available.
Source: AMA
Click here for an initial guide to the major provisions in the “No Surprises Act,” the surprise billing legislation that was included in the Consolidated Appropriations Act COVID-19 relief bill signed into law on December 27, 2020. The No Surprises Act allows for price transparency, provider directories, and patient financial protections that impact health plans, physicians, facilities, and other non-MD/DO licensed health care professionals. The law goes into effect on January 1, 2022. The intent of the law is not to preempt state surprise billing laws. However, there is some ambiguity in the statutory language that will require further clarification before and during the rulemaking process, including when the surprise billing protections apply to patients in self-funded ERISA plans. The AMA will work with Federation members and other stakeholders to seek clarification to address these ambiguities and will revise this guide accordingly as new information becomes available.
Source: AMA
January 2021
Federal action on surprise medical bills: What doctors should know
Patients will be protected from unexpected medical costs, while out-of-network physicians other clinicians and facilities will have a process available to challenge inadequate out-of-network payment from commercial health insurance companies.
These provisions, which take effect Jan.1, 2022, are part of the No Surprises Act that was folded into the Consolidated Appropriations Act, 2021, a comprehensive, $1.4 trillion legislative package that included COVID-19 related relief for physicians and appropriations to fund government operations through the end of fiscal year 2021, which ends Sept. 30.
Read more: https://www.ama-assn.org/delivering-care/patient-support-advocacy/federal-action-surprise-medical-bills-what-doctors-should
Patients will be protected from unexpected medical costs, while out-of-network physicians other clinicians and facilities will have a process available to challenge inadequate out-of-network payment from commercial health insurance companies.
These provisions, which take effect Jan.1, 2022, are part of the No Surprises Act that was folded into the Consolidated Appropriations Act, 2021, a comprehensive, $1.4 trillion legislative package that included COVID-19 related relief for physicians and appropriations to fund government operations through the end of fiscal year 2021, which ends Sept. 30.
Read more: https://www.ama-assn.org/delivering-care/patient-support-advocacy/federal-action-surprise-medical-bills-what-doctors-should
CMS Puts Patients Over Paperwork with New Rule that Addresses the Prior Authorization Process
Today, the Centers for Medicare & Medicaid Services (CMS) finalized a signature accomplishment of the new Office of Burden Reduction & Health Informatics (OBRHI). This final rule builds on the efforts to drive interoperability, empower patients, and reduce costs and burden in the healthcare market by promoting secure electronic access to health data in new and innovative ways. These significant changes include allowing certain payers, providers and patients to have electronic access to pending and active prior authorization decisions, which should result in fewer repeated requests for prior authorizations, reducing costs and onerous administrative burden to our frontline providers. This final rule will result in providers having more time to focus on their patients and provide higher quality care.
“Today, we take a historic stride toward the future long promised by electronic health records but never yet realized: a more efficient, convenient, and affordable healthcare system,” said CMS Administrator Seema Verma. “Thanks to this rule, millions of patients will no longer have to wrangle with prior providers or locate ancient fax machines to take possession of their own data. Many providers, too, will be freed from the burden of piecing together patients’ health histories based on incomplete, half-forgotten snippets of information supplied by the patients themselves, as well as the most onerous elements of prior authorization. This change will reverberate around the healthcare system for years and decades to come.”
Read more: www.cms.gov/newsroom/press-releases/cms-puts-patients-over-paperwork-new-rule-addresses-prior-authorization-process
Today, the Centers for Medicare & Medicaid Services (CMS) finalized a signature accomplishment of the new Office of Burden Reduction & Health Informatics (OBRHI). This final rule builds on the efforts to drive interoperability, empower patients, and reduce costs and burden in the healthcare market by promoting secure electronic access to health data in new and innovative ways. These significant changes include allowing certain payers, providers and patients to have electronic access to pending and active prior authorization decisions, which should result in fewer repeated requests for prior authorizations, reducing costs and onerous administrative burden to our frontline providers. This final rule will result in providers having more time to focus on their patients and provide higher quality care.
“Today, we take a historic stride toward the future long promised by electronic health records but never yet realized: a more efficient, convenient, and affordable healthcare system,” said CMS Administrator Seema Verma. “Thanks to this rule, millions of patients will no longer have to wrangle with prior providers or locate ancient fax machines to take possession of their own data. Many providers, too, will be freed from the burden of piecing together patients’ health histories based on incomplete, half-forgotten snippets of information supplied by the patients themselves, as well as the most onerous elements of prior authorization. This change will reverberate around the healthcare system for years and decades to come.”
Read more: www.cms.gov/newsroom/press-releases/cms-puts-patients-over-paperwork-new-rule-addresses-prior-authorization-process
Extension of the PHE & Implementation of Medicare Payment Changes in Consolidated Appropriations Act
HHS Secretary Azar has extended the COVID-19 Public Health Emergency (PHE) declaration effective Jan. 21, 2021 for an additional 90 days. This means that all of the telehealth and other waivers and flexibilities that have been implemented during the PHE will remain in effect until at least April 21, 2021.
In addition, as indicated in the summary and impact table distributed earlier this week, the Consolidated Appropriations Act that was signed into law on Dec. 27, 2020, included provisions that offset most of the 10.2% budget neutrality adjustment that had been slated to take effect for Medicare-covered services provided as of Jan. 1, 2021. CMS has now confirmed that it is implementing the following provisions of this legislation and that there will be no delay in claims processing for 2021 services; that is, claims will be paid on time at the correct 2021 rates that reflect this legislation.
Message from CMS:
On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS):
Source: AMA
HHS Secretary Azar has extended the COVID-19 Public Health Emergency (PHE) declaration effective Jan. 21, 2021 for an additional 90 days. This means that all of the telehealth and other waivers and flexibilities that have been implemented during the PHE will remain in effect until at least April 21, 2021.
In addition, as indicated in the summary and impact table distributed earlier this week, the Consolidated Appropriations Act that was signed into law on Dec. 27, 2020, included provisions that offset most of the 10.2% budget neutrality adjustment that had been slated to take effect for Medicare-covered services provided as of Jan. 1, 2021. CMS has now confirmed that it is implementing the following provisions of this legislation and that there will be no delay in claims processing for 2021 services; that is, claims will be paid on time at the correct 2021 rates that reflect this legislation.
Message from CMS:
On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS):
- Provided a 3.75% increase in MPFS payments for CY 2021
- Suspended the 2% payment adjustment (sequestration) through March 31, 2021
- Reinstated the 1.0 floor on the work Geographic Practice Cost Index through CY 2023
- Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024
Source: AMA
Telehealth Claim Lines Increase 3,060 Percent Nationally When Comparing October 2019 to October 2020
Telehealth claim lines increased 3,060 percent nationally from October 2019 to October 2020, rising from 0.18 percent of medical claim lines in October 2019 to 5.61 percent in October 2020, according to new data from FAIR Health’s Monthly Telehealth Regional Tracker. From month to month, coinciding with a surge in COVID-19 cases in October, the telehealth share of medical claim lines rose 10.6 percent nationally, from 5.07 percent in September 2020 to 5.61 percent in October 2020. The data represent the privately insured population, excluding Medicare and Medicaid. Click here to read more
Source: Fair Health
Telehealth claim lines increased 3,060 percent nationally from October 2019 to October 2020, rising from 0.18 percent of medical claim lines in October 2019 to 5.61 percent in October 2020, according to new data from FAIR Health’s Monthly Telehealth Regional Tracker. From month to month, coinciding with a surge in COVID-19 cases in October, the telehealth share of medical claim lines rose 10.6 percent nationally, from 5.07 percent in September 2020 to 5.61 percent in October 2020. The data represent the privately insured population, excluding Medicare and Medicaid. Click here to read more
Source: Fair Health
What Stark law, anti-kickback changes mean for value-based care at ASCs
01/06/2021
HHS issued two rules on value-based care arrangements recently that will affect orthopedic surgeons and ASCs.
CMS made adjustments to the Stark law, and HHS updated the federal Anti-Kickback Statute and the civil monetary penalties law to ensure healthcare providers could develop value-based care arrangements without fear of fraud and abuse charges. The changes to the Anti-Kickback Statute make it easier to enter into value-based care arrangements, especially if providers take full risk.
Read more at: https://www.beckersasc.com
01/06/2021
HHS issued two rules on value-based care arrangements recently that will affect orthopedic surgeons and ASCs.
CMS made adjustments to the Stark law, and HHS updated the federal Anti-Kickback Statute and the civil monetary penalties law to ensure healthcare providers could develop value-based care arrangements without fear of fraud and abuse charges. The changes to the Anti-Kickback Statute make it easier to enter into value-based care arrangements, especially if providers take full risk.
Read more at: https://www.beckersasc.com
Anthem reportedly undergoing DOI ‘Market Conduct Review’
The Medical Association of Georgia (MAG) is receiving reports that Georgia’s Department of Insurance is conducting an “examination” of Anthem’s conduct in Georgia – so MAG is encouraging physicians and applicable practice staff to report every instance that Anthem has not fulfilled its contract obligations.
Georgia law states that, “The Commissioner may, when the Commissioner deems it reasonably necessary to protect the interests of the public, examine the business and affairs of any licensee or applicant for a license.”
MAG Corporate Relations Director Ryan Larosa explains that, “Georgia Insurance Commissioner John King has broad power to protect consumers, and we have been working with other physician/patient organizations to address Anthem’s inappropriate business practices. These conduct reviews can look at business practices from prior years, so physicians should report every instance that Anthem has not fulfilled its contract obligations.”
Physicians and practice staff should contact DOI’s Gregg Conley at gconley@oci.ga.gov to report every instance that Anthem has not fulfilled its contract obligations.
Contact Ryan M. Larosa, MBA at rlarosa@mag.org with questions.
The Medical Association of Georgia (MAG) is receiving reports that Georgia’s Department of Insurance is conducting an “examination” of Anthem’s conduct in Georgia – so MAG is encouraging physicians and applicable practice staff to report every instance that Anthem has not fulfilled its contract obligations.
Georgia law states that, “The Commissioner may, when the Commissioner deems it reasonably necessary to protect the interests of the public, examine the business and affairs of any licensee or applicant for a license.”
MAG Corporate Relations Director Ryan Larosa explains that, “Georgia Insurance Commissioner John King has broad power to protect consumers, and we have been working with other physician/patient organizations to address Anthem’s inappropriate business practices. These conduct reviews can look at business practices from prior years, so physicians should report every instance that Anthem has not fulfilled its contract obligations.”
Physicians and practice staff should contact DOI’s Gregg Conley at gconley@oci.ga.gov to report every instance that Anthem has not fulfilled its contract obligations.
Contact Ryan M. Larosa, MBA at rlarosa@mag.org with questions.
