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March 31, 2020

Medicare regulations important for GIs

High-level overview of the resources available to you and your practice.
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Medicare released temporary regulatory waivers and new rules to equip the U.S. health care system with additional flexibility to respond to the 2019 Novel Coronavirus (COVID-19) public health crisis. Below is a top-level summary of the most important provisions to gastroenterologists.

Telehealth expansions

Building on the telehealth rules changes earlier this month:

  • Phone calls are now considered telehealth services.
  • E/M level selection for telehealth can be based on medical decision making or time and CMS has temporarily removed any requirements regarding documentation of medical history and/or physical exam in the medical record during the COVID-19 crisis.
  • More services are now considered telehealth, including observation and observation discharge day management.
  • Providers can report telehealth for new and established patients, even if the code is specifically for established patients.

New opportunities for ACSs

Local ambulatory surgical centers (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.

New financial assistance

Most providers who participate in Medicare fee-for-service 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

MIPS Changes

  • Clinicians who have been adversely affected by the COVID-19 public health emergency can apply and request reweighting of the Merit-based Incentive Payment System (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 CY 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.

New Stark exceptions

Certain referrals and the submission of related claims that would otherwise violate the Stark Law are allowed during the COVID-19 emergency:

  • 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.
  • Additional exceptions can be found in the CMS information sheet for providers.

New physician supervision rules

For services requiring direct supervision by the physician or other practitioner, that physician supervision can be provided virtually using real-time audio/video technology.

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