CMS issues more rule changes to cope with COVID-19 — are they enough?
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CMS recently announced a second round of regulatory waivers and rule changes to expand care to the nation’s seniors and provide health care systems flexibility.
Though physicians applauded the new measures, they also said that CMS could do more to help primary care physicians recover from the financial toll of COVID-19.
Some of the latest actions include the following:
- CMS is waiving the video requirement for certain telephone evaluation and management services and adding them to the list of Medicare telehealth services.
- Payments for telephone visits related to behavioral health and patient education services match similar office and outpatient visits.
- Orders are no longer required for Medicare beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis.
- Hospitals and practitioners evaluating Medicare beneficiaries and collecting laboratory samples for COVID-19 testing will receive separate payment when that is the only service the patient receives.
- Medicare and Medicaid will cover certain serology (antibody) tests that help determine if a person may have developed an immune response and may not be at immediate risk for COVID-19 reinfection.
- Health care providers have greater flexibility during the pandemic to increase the number of beds for patients with COVID-19 while receiving stable, predictable Medicare payments.
- Hospital systems that include rural health clinics can increase their bed capacity without affecting the rural health clinic’s payments.
- CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.
- CMS is allowing payment for outpatient hospital services (eg, wound care, drug administration and behavioral health services) delivered in temporary expansion locations when the locations are temporarily designated part of a hospital.
- CMS is allowing certain provider-based hospital outpatient departments that relocate off-campus to obtain a temporary exception and continue to be paid under the Outpatient Prospective Payment System.
- Medicare payments for teaching hospitals that send residents to other hospitals for COVID purposes will not be reduced; nonteaching hospitals that accept residents will not be penalized.
- Requirements for ambulatory surgery centers to intermittently reappraise medical staff privileges during the COVID-19 emergency declaration are waived.
- Nurse practitioners, clinical nurse specialists and physician assistants can provide home health services; establish and periodically review such patients’ care; and certify and re-certify the patient’s home health services’ eligibility.
- Clinicians can allow more of their patients with diabetes to monitor glucose and adjust insulin doses at home.
- Accountable Care Organizations can extend their status for 1 year without an application; the risk these organizations take will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic.
Health care professionals can begin implementing these actions immediately, CMS stated. CMS’ regulatory waivers and rule changes that were announced during the pandemic are in effect until the national Public Health Emergency Declaration expires.
“CMS is seeking to capitalize on our gains by helping to safely reopen the American health care system in accord with President Trump's guidelines,” Seema Verma, MPH, CMS administrator, said in the release. – by Janel Miller
Perspective
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Conrad L. Flick, MD
These regulatory waivers and rule changes are good news. However, the proof of their value to primary care physicians is in the pudding.
It is nice to know that COVID-19 testing for Medicare recipients is going to be covered, but that does not necessarily mean tests are available. We also hope the tests are reliable. Expanding telehealth to include phone calls is also helpful, as many beneficiaries who are aged 65 years and older still have a difficult time with technology or do not have access to the technology that is needed for video calls..
The Paycheck Protection Program — which my office received a check from — is helpful but will only help a small percentage of practices in the United States. Without that check, we would have had to lay off at least a third of my staff.
However, we are still are unsure how long the pandemic will last and whether patient volumes will pick back up to cover our overhead. Office visits are down 30% and we still cannot take care of our patients like we are used to. Our patients still want and need their refills. They still want their questions answered. There are stories of people dying from heart attacks and people having strokes and other acute illnesses requiring attention and not going to the doctor’s office or emergency department because they are afraid of COVID-19. As a result, some of these patients have died or have significant morbidity because of delay in treatment.
There is a cost to keeping offices open to provide basic and needed services to our patients. For this reason, CMS should now consider paying PCPs with a monthly outlay or other kind of per beneficiary, per month payment to practices. This would help assure that physician offices could remain open and accessible when needed by some of our most vulnerable patients.
Perspective
Back to TopJacqueline W. Fincher, MD, FACP
One of the most important details from this latest CMS announcement is that telephone visits will be paid at the same rate as the Evaluation and Management codes 99212 through 99214. This is a huge win, particularly for primary care. This is also a huge win for practices in rural areas and for practices with large Medicare populations, as these practices typically serve more vulnerable populations with less resources. The adjustment for the Accountable Care Organization methodology is also significant as no one anticipated a pandemic in the middle of a risk-based payment model.
We now request that CMS make telephone call reimbursement — which is right now based on time only — to become equivalent to the regular telehealth visit that involves medical decision-making or time to determine code selection. Reimbursement should not be based on just time spent with a patient. We are also very concerned that the Accelerated Advance Payment program has been temporarily stopped. In addition, we would like to see the recoupment period of that program change to begin a year after payment and have the loan be interest free. Furthermore, we need some clarity around Annual Wellness Visits. If we are doing these visits via telehealth, and the patient does not have a blood pressure monitor or scale, we cannot document these elements of the Annual Wellness Visits. Our concern is that Medicare carriers will reject these visits and not reimburse for them because these elements are missing.
Perspective
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Neil H. Baum, MD
The new CMS rule that telephone visit reimbursements will now match that of office visits is very good news for physicians. Lack of reimbursements was a significant deterrent from participating in telehealth.
During the COVID-19 pandemic, telehealth in long-term and rehabilitation facilities is crucial to be able to treat patients without having to transfer them to a hospital, which limits the risk for exposure to others — patients, staff and visitors. Telehealth offers the possibility of physical separation while maintaining clinical quality. These programs will also most likely positively impact efficiency and morale and reduce staff, patient and family stress.
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