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April 13, 2020

Medicare gives providers new flexibility and rules during COVID-19

Our experts provide a top-level summary of the most important provisions to gastroenterologists.
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Medicare released temporary regulatory waivers and new rules to give providers additional flexibility to respond to the 2019 Novel Coronavirus (COVID-19) public health emergency (PHE).

  • Telehealth reporting and rules have changed during the public health emergency (PHE)
  • Providers can deliver telehealth via commonly used apps like FaceTime, Skype and Zoom.
  • Providers must report the place of service for telehealth services where the E/M visit would have been provided prior to the public health emergency (e.g., 11-office, 22-hospital outpatient, 24-ASC) and add telehealth modifier 95.
  • CMS waived the requirement for documentation of history and physical exam in the medical record for office/outpatient E/M telehealth and will allow a level of E/M selection to be based on medical decision making or time.
  • Providers can report telehealth for new and established patients even if the E/M code specifically states it is for established patients.
  • E/M provided via audio-only communications (telephone) must be reported with telephone E/M codes 99441-99443, which are reimbursed at $15-$39 nationally and are now covered by Medicare.
  • Expansion of the Accelerated/Advance Payment Program
  • Allows providers who participate in Medicare fee-for-service to receive an advance on future payments.
  • Most providers can request up to 100% of their Medicare payment amount for a three-month period. Repayment begins 120 days after you receive your advance and you will have 210 days from the date of the advance payment was made to repay the balance. Repayment is automatic and is deducted from every claim submitted to repay the accelerated/advanced payment.
  • CMS approved over $51 billion for providers via the Accelerated/Advance Payment Program over the past week.
  • New opportunities available for ambulatory surgical centers (ASCs) to continue operating
  • ASCs that have canceled elective surgeries, per federal recommendations, can contract with local health care systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their state’s emergency preparedness or pandemic plan.
  • The new flexibilities will also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries.
  • Some requirements in national and local coverage determinations waived
  • Face-to-face and in-person requirements in national or local coverage determinations (including articles) for evaluations, assessments, certifications or other implied face-to-face services do not apply for the duration of the COVID-19 emergency.
  • New flexibility added for Merit-based Incentive Payment System (MIPS) reporting
  • April 30, 2020, is the new deadline to submit 2019 performance data for MIPS under the Medicare Quality Payment Program.
  • MIPS-eligible physicians and other clinicians who do not submit data by April 30 will qualify for the “automatic extreme and uncontrollable circumstances” policy and will automatically avoid a MIPS-related penalty and, instead, receive a neutral payment adjustment for the 2021 MIPS payment year.
  • Clinicians who have been adversely affected by the COVID-19 public health emergency can apply and request reweighting of the MIPS performance categories for the 2019 performance year. This will allow clinicians who may be unable to submit their MIPS data during the current submission period to request reweighting and potentially receive a neutral MIPS payment adjustment for the 2021 payment year.
  • A new COVID-19 Improvement Activity for the calendar year 2020 performance year that, if selected, will provide high-weighted credit for clinicians within the MIPS Improvement Activities performance category. Clinicians will receive credit for this Improvement Activity by participating in a clinical trial utilizing a drug or biological product to treat a patient with COVID-19 and then reporting their findings to a clinical data repository or clinical data registry.
  • Certain referrals and submissions of related claims that would otherwise violate the Stark Law allowed during PHE
  • Hospitals and other health care providers can pay above or below fair market value to rent equipment or receive services from physicians (or vice versa).
  • Health care providers can support each other financially to ensure continuity of health care operations. For example, a physician owner of a hospital may make a personal loan to the hospital without charging interest at a fair market rate so that the hospital can make payroll or pay its vendors.
  • Adjustments to physician supervision rules allow new flexibility
  • For services requiring direct supervision by the physician or other practitioner, that physician supervision can be provided virtually using real-time audio/video technology.

For questions or concerns about the Medicare updates listed, contact Leslie Narramore at

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