Medicare Payment Increased for 3 Healthcare Providers Says CMS

CMS (The Centers for Medicare and Medicaid Services) decides to upgrade the Medicare payment adjustments for three types of physicians namely:

  • Hospices
  • Skilled nursing facilities
  • Inpatient psychiatric facilities

This step is great in order to reward the healthcare professionals in the respective facilities for their up-scaled services, especially during the pandemic.

How it will impact the Hospices?

Right from the year 2021, hospice payment rates will be raised by the market basket percentage of 2.4%. In numbers, this percentage is around $540 million.

Where CMS has shown support in the payment rate, they also demand quality reporting services. Hospices failed to meet the performance threshold will have to face a 2% decline in the annual payment market basket.

The system also has a statutory aggregate cap that puts a limit to payments made to the hospices.

The final cap amount for FY 2021 is $30,683.93 updated by 2.4% as per 2020.

How it will impact the Skilled Nursing Facilities?

The aggregate payments to skilled nursing facilities are going to increase by 2.2%, in 2021, which is $750 million.

These facilities are upgraded by the routine technical rate-setting updates in payments. The final rule also applies a 5% cap on the wage index, which is lower than in 2020. Hearing the concerns of the stakeholders, CMS also tweaked the ICD 10 code maps, which will be in effect from 2021.

The updated mapping address the care based patient characteristics under  Medicare Patient-Driven Payment Model.

However, the payments for skilled nursing facilities depend on the performance of a single claims-based, all-cause, all-condition hospital readmission measure.

How it will impact the Inpatient Psychiatric Facilities?

Inpatient psychiatric facilities will observe an increase in their payment rate by 2.2%, estimated to be $95 million in 2021.

Office of Management and Budget statistical area delineations will be revised to better estimate the cost born by the healthcare professional.

With this update, the following physicians will be able to practice within the scope determined by the state law.

Advanced practice providers including:

  • Physician assistants
  • Nurse practitioners
  • Psychologists
  • Clinical nurse specialists

They also have to record the progress of their patient along with the medical record.

Further efforts would be required to dissolve the inconsistencies that don’t align with the latest final rules changes and to loosen the regulatory conditions.

We hope CMS brings more innovations to reduce administrative burden and improve payment rates for all physicians.

For more updates, visit our page – https://www.p3care.com/blog

Medical billing services, healthcare system, healthcare practitioners, medical billing companies, healthcare professionals, Medicare and Medicaid Services

CMS Prioritizes Surveys Post Pandemic for the safety of patients

Every business came to a halt with the COVID-19 pandemic. Now, everything is settling back to normalcy, and CMS is getting back to business with its full strength.

They have officially asked state survey agencies to get on with the normal operations.

According to the CMS (The Centers for Medicare and Medicaid Services) memo, they will be inspecting and regulating quality and safety measures for patients of their authorized healthcare professionals, medical billing services, and other care suppliers. They are to resume their enforcement activities and other surveys in order to get an idea of their performance having patients being the priority.

How Is It Going to Work?

The last few months were hectic for the CMS. They were conducting surveys about the virus control and response in particular, virtually from all nursing homes in America.

However, now non-emergency onsite revisit surveys will be conducted. Compliant surveys and annual certification surveys will now be more focused upon, as soon the right resources are accessible to the team. The on-hold enforcement cases will also see the light of day and be resolved.

CMS also says that they will continue with the desk review policy to ensure that survey parties comply with the federal rules for an onsite survey.

Even during the catastrophic pandemic situation, CMS only focused on patients’ satisfaction.

“They have imposed more than $15 million in civil money penalties (CMPs) to more than 3,400 nursing homes during the public health emergency for non-compliance with infection control requirements and the failure to report coronavirus disease 2019 (COVID-19) data.” (Source: CMS)

Protect the Residents of Nursing Homes

The penalties were an extension to Trump’s vision of safeguarding the residents of nursing homes during the pandemic. However, CMS ensures some comfort as via relaxing the strict quality measures requirements based on the critical situation in any particular state.

Provider Surveys in Progress for a Stable Healthcare System

Given below is the list of types of surveys that would be in the top priority.

The idea is to give healthcare professionals and medical practices the ease to estimate their survey turn and plan accordingly.

The FY 2020 Mission & Priority Document highlighted how survey agencies should resume back to normal work.

  1. Initial surveys of new providers
  2. Special Purpose Renal Dialysis Facilities (SPRDFs)
  3. Past-due recertification surveys without a statutorily required survey interval
  4. Unfinished complaint surveys triaged as non-immediate Jeopardy level or higher
  5. Revisit surveys for past non-compliance that do not otherwise qualify for a desk review
  6. Past-due recertification surveys with a statutorily required survey interval (home health agencies and hospices must be surveyed every 36 months)

(Source: AAPC)

As medical billing companies and healthcare practitioners, we should be ready for audits and surveys, which will also help us to see where we stand in a progressive healthcare system.

Provider medical billing service, medical billing, Telehealth Services, CMS updates, Public Health Emergency

COVID-19: Public Health Emergency Telehealth Services to SNF Residents

CMS keeps on providing useful information as the COVID-19 pandemic drags on. In fact, the rebuilding efforts shall continue until a significant vaccine emerges to the scene and puts an end to this virus. When America, on one side, faces the challenge of COVID-19 testing kits shortages, on the other, it is the people who must work on their emotional resilience to continue to survive the 2020 pandemic.

Emotional resilience, the art of managing one’s emotions through the crisis has become even more crucial.

Coming back to today’s topic, the COVID-19 Public Health Emergency (PHE) does not relax the overall requirements for Skilled Nursing Facility (SNF) Consolidated Billing (CB); however, CMS releases a set of CPT telehealth codes for coverable time segments as long as the crisis lasts.

New Telehealth Reimbursement-ready Codes

Telemedicine codes like:

  • 99441,
  • 99442, and
  • 99443

assign three different time evaluations of telephonic Evaluation and Management (E&M) services by the provider. Physicians must bill for these services under Part B when providing care to an SNF’s Part A resident.

After such an announcement by CMS, Medicare Administrative Contractors (MACs) will reevaluate claims – for codes 9941, 99442 and 99443 – with service dates on or after March 1, 2020, that were denied because of SNF CB changes. You just have to sit tight and wait for the collections column to fill up. In case there is a provider medical billing service working on your behalf, they will update you once payments come through.

For those of you who have received payments from an SNF for telehealth services, it is obligatory to return them to the facility once the MAC repurposes your claim.

With COVID-19 still around, these changes had to be released eventually. On the whole, CMS finalized three payment rules for Medicare on July 31, 2020; they concur with payments for Inpatient Psychiatric Facilities (IPF), Skilled Nursing Facilities, and hospices.

We only wrote details for one of them – for SNFs.

CMS depicts an increase in total payments to SNFs by $750 million for FY 2021 or a 2.2 percent increase compared to FY 2020.

To know more about telemedicine’s remedial effects during the pandemic, we crafted a piece on our blog section: Telemedicine Emerges as Cure Outlet Amid the COVID-19 Outbreak. It gives you an outline of where we are headed to with remote visits.

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CMS announces QPP MIPS reporting Relaxations for 2020

The last few months have been tough for the healthcare industry. All stakeholders were trying desperately to assist each other and save resources for COVID-19 response.  Of course, meanwhile, CMS also took necessary measures to unburden some of the clinicians’ load.

Where physicians have already burned out with COVID -19 cases, the administrative burden of QPP MIPS 2020 was additional pressure. The dynamics have changed. The contact points that were easily accessible before are now operational via online mediums.

Thus, eligible clinicians and MIPS Qualified Registries can take benefit from it and serve effortlessly to the patients.

At first, CMS requested clinicians to impede elective medical procedures. In simple terms, it means to delay diagnostic procedures or treatments that don’t qualify for emergency conditions.

However, the process of offering flexibilities continues for the QPP MIPS. At first, CMS asked healthcare professionals to delay elective medical procedures and treatments, but with things starting to get back to normal, the Trump administration reopens all medical practices.

Telehealth was another option that was promoted to continue the services along with COVID response. QPP MIPS 2020 is also going to reward physicians who adopted telehealth and practiced it to accommodate patients from every corner. It not only accounts for improvement activities but for promoting interoperability.  It is a great opportunity for scoring high and target incentives.

The following are the relaxation areas that MIPS eligible clinicians can enjoy.

Relaxations for the QPP MIPS 2020

CMS states that the eligible clinicians who are significantly impacted by the public health emergency can apply for Extreme and Uncontrollable Circumstances to reweight any of the four or all MIPS performance categories.

However, they are required to submit a solid explanation for the impact on their medical practice.

A COVID-19 clinical Improvement Activity under MIPS is also introduced by the CMS.  Eligible clinicians can obtain outcomes via:

  • Participating in a COVID-19 clinical trial Improvement Activity and submit data into a data platform
  • Participating in the healthcare of COVID-19 infectees and submit patients’ data to Clinical Data Registry for research

As physicians are busy battling against coronavirus pandemic, CMS has decided to not use data reflecting from January 1st to June 30th, 2020 for the Medicare Quality Reporting and value-based purchased programs. These measures are taken to give advantage to eligible physicians to some extent as to minimize the administrative burden incurred during data collection and management. A lot of time and investment can be saved, henceforth.

medical billing service, MIPS Qualified Registry, CMS news, Trump’s Guidelines, COVID-19, coronavirus , COVID-19 outbreak, MIPS 2020 reporting, QPP MIPS, MIPS 2020 reporting registry, QPP 2020 Reporting

P3 Investigates: Trump Administration Plans to Reopen Nursing Homes

P3, as a medical billing service and a MIPS Qualified Registry, keeps in touch with CMS news as it happens. CMS, yet again, informs the public of the plans, the government has for nursing homes to reopen safely with the pandemic still around. While state and local officials follow it to ensure safe beginnings for nursing homes across the country, they are a part of President Trump’s Guidelines for Opening Up America Again.

Why were the restrictions put in the first place? The government had to take stern action against nursing homes and put them under quarantine to prevent the spread of COVID-19, including severe infection prevention, ample testing, and investigation.

This plan that the government has come up with will be a guide through troubling times as life gets back to normal for nursing homes.

When stats suggest that 8 out of 10 COVID-19 deaths are of citizens 65 and above, the more careful we are the better. We owe it to the seniors of this country more than we owe it to anyone else.

By acting upon this guide, nursing homes will be able to mitigate the risk of COVID-19 exposure and prevent its spread within facilities.

In light of these issued recommendations, states should observe if nursing homes are taking the appropriate and necessary steps to ensure resident safety; moreover, they should know the right time when to reopen doors to the public.

In finality, the information you find here should support states and nursing homes bring families together, reunite them with their loved ones in a gradual manner.

Administrator Seema Verma has led from the front during the crisis; this time, she said and I am paraphrasing it; the coronavirus has had a shocking impact on our nursing homes, and as we reopen the country, we want to be sure that we are doing everything in our power to protect our most vulnerable citizens.

She continued by saying that their constant focus is on the protection and quality of life of the nursing home residents. While we reach the stage when we finally reopen, she said, we want to make sure that the communities have a set strategy moving forward.

Further, CMS recommends additional criteria for the safety of the nursing home residents since COVID-19 poses a direct threat to them as the country passes through the reopening phase. It is to complement the Trump Administration’s broader idea of the Reopening of America Again.

A nursing home, as part of the recommendation, must not advance through phases of reopening until all residents and staff have received their baseline test results.

CMS wants state survey agencies to keep an eye on nursing homes if they suffered from a serious COVID-19 outbreak before reopening.

As its final recommendation, CMS states that homes should remain in the highest state of restriction even if they see relaxation in the community around them, to ensure the preservation of lives.

Moving on, nursing homes will start taking in visitors in phase three, which will only occur when health reports show considerably less COVID-19 cases. Visitors must go through screening and wear a face-covering during the visit.

The guidance was released a couple of days back on May 18, 2020, but we thought by revisiting the recommendations, we can make a difference. P3, as QPP MIPS 2020 reporting registry, has considered it an honor to go the distance for the health of US citizens; this, specifically, goes out to seniors to whom we are grateful.

State leaders in collaboration with local health departments and state survey agencies would implement the guidance to limit COVID-19 exposure in nursing homes. Relaxation of the intense measures in a nursing home should only occur after a careful review of the following factors:

  • Number of COVID-19 cases in the local community
  • Number of COVID-19 cases in nursing homes
  • Available staff members
  • Baseline tests of all residents; weekly tests of all staff members; social distancing; face coverings
  • Presence of enough personal protective equipment (PPE)
  • Nearby hospital’s capacity

State and local leaders have a responsibility to see to these factors now and then and adjust their strategies accordingly, depending on the intensity of coronavirus spread in their vicinity. CMS is committed to taking measures that ensure the safety and revival of nursing homes.