Tuesday, August 11, 2020

HHS Updates FAQs with Medicaid, Cost Report and CHOW Information

On August 11, HHS changed terminology describing various allocations and added FAQs on availability of Medicaid awards.

Terminology 

HHS has renamed the first two tranches “Phase 1 – General Distribution” and has renamed what had been the Medicaid tranche “Phase 2 – General Distribution.” Therefore, future HHS notices on what were referred to as “Tranche 1” and/or “Tranche 2” will be described as “Phase 1 – General Distribution.” The Medicaid, CHIP, and Dental Allocation now will be described as “Phase 2 – General Distribution.” 

Phase 2 – General Distribution Availability 

Initially, HHS indicated that providers who received a Phase 1 – General Distribution were not eligible for a Phase 2 – General Distribution. Today, HHS reversed its position in the following FAQ: 
“Medicaid and CHIP Providers who have received a payment under Phase 1 of the General Distribution are no longer prohibited from submitting an application under Phase 2 of the General Distribution. Providers who received a previous Phase 1 – General Distribution payment are eligible to apply and, if they have not yet received a payment that is approximately 2% of annual revenue from patient care, may receive additional funds (see pages 35-36).” 
In order to apply for Phase 2 General Distribution funds, providers who received a Phase 1 - General Distribution payment that was less than 2% of revenue from patient care must meet the revised eligibility requirements for the Phase 2 - General Distribution and follow the application instructions available for the distribution.

Applicants should use the Provider Relief Fund Application and Attestation Portal to apply for funds. Payments received as part of the Phase 1 - General Distribution will be taken into account when determining payment amounts for the Phase 2 - General Distribution. Finally, if you were eligible for the Phase 1 – General Distribution and rejected the payment, you are now eligible to apply for Phase 2 – General Distribution payment that is approximately 2% of revenue from patient care. 

Change of Ownership (CHOW) Update 

The Phase 2 – General Distribution web portal for Medicaid, CHOW, and Phase 1 – General Distribution awardees who missed the June 3 cut off for additional funding is up but still is not active. AHCA/NCAL will provide information as soon as the portal is operational.




For more information, please visit www.ahcancal.org/coronavirus or email COVID19@ahca.org

Dialysis Treatment for Long Term Care Residents During COVID-19

COVID-19 infection risks are associated with long term care residents requiring outside medical appointments, including dialysis. These risks are impacted by the processes around these medical appointments, including transportation and the status of infection control practices at the dialysis center or other community medical provider. Everyone plays a key role in reducing the risk of infection spread, including the long term care facility, dialysis providers, and state and federal policy makers and partners. Improved and regular communication among these stakeholders is critical to improve outcomes and minimize infection risk. 

Long term care providers have identified some challenges in working with dialysis centers to manage COVID-19 risks for residents who require dialysis. These challenges include: 
  • Differences in infection prevention and control practices and standards, including PPE, dedicated staff, and social distancing. 
  • Transportation to and from the dialysis center, including residents traveling long distances due to closures of some dialysis facilities, especially in rural areas. 
  • Challenges with guidance and practices around cohorting and isolation for dialysis patients. 
The following are potential solutions that may be helpful to minimize risk and improve outcomes:
  • Seek opportunities to revise schedules with the dialysis center to minimize co-mingling of long term care residents with community patients in the same room during the same dialysis session, utilize separate spaces for each group, and facilitate dedicated staff and equipment for each cohorted group. 
  • Ask the dialysis center to ensure social distancing between all people, including patients and staff, using physical separations whenever possible due to risk of asymptomatic spread. 
  • Seek information from dialysis centers about their infection prevention and control policies and procedures to identify areas of opportunity for process improvement, including staff and community patient testing based on prevalence in the surrounding community. 
  • Request timely communications from dialysis centers for any infection control issues or lapses to the nursing home, so that the nursing home can be aware and manage accordingly. 
  • Seek and create alternative approaches to dialysis during COVID-19 pandemic, including more on-site dialysis opportunities within nursing homes where possible. 
Reach out directly to the dialysis centers your facility works with to engage in dialogue about current practices and seek collaboration in areas for improvement. 

For more information, please visit www.ahcancal.org/coronavirus or email COVID19@ahca.org

HHS Opens CHOW Portal

Starting today, August 10, providers who underwent a Change of Ownership (CHOW) and providers who missed the June 3, 2020 deadline to apply for additional funding equal to 2 percent of their total patient care revenue from the $20 billion portion of the $50 billion Phase 1 General Distribution may submit their application for possible funds by August 28, 2020. This deadline aligns with the extended deadline for other eligible Phase 2 providers, such as Medicaid. As of this evening, the portal does not appear to be fully operational.

Latest Eligible Providers for Phase 2 General Distribution Funding 

  • Providers who were ineligible for the Phase 1 General Distribution because: 
    • They underwent a change in ownership in calendar year 2019 or 2020 under Medicare Part A; and 
    • Did not have Medicare Fee-For-Service revenue in 2019. 
  • Providers who received a payment under Phase 1 General Distribution but: 
    • Missed the June 3 deadline to submit revenue information – including many Medicaid providers with low Medicare revenues that assumed they were ineligible for additional distribution targeted at Medicare providers or had planned to apply for a Medicaid and CHIP specific distribution; or 
    • Did not receive Phase 1 General Distribution payments totaling approximately 2 percent of their annual patient revenue.
  • Providers who previously received Phase 1 General Distribution payment(s) but rejected and returned the funds and are now interested in reapplying. 

HHS notes eligible providers will only receive funding of up to 2 percent of their reported total revenue from patient care. Therefore, for providers who have already received a Phase 1 General Distribution payment from HHS, the previous amount received and kept will be taken into account when determining the eligible amount for Phase 2 General Distribution payment. All payment recipients must accept HHS's terms and conditions and may be subject to auditing to ensure the data provided to HHS for payment calculation are accurate. 

HHS has been hosting a series of informational webinars to address questions and support providers through the application process. The next provider and provider organization webinar will be held on Thursday, August 13, 2020.




PT/OT Professionals – It’s Time to Learn About a New Approach for Addressing Functional Decline in SNF Patients

Dave Kyllo

In collaboration with the University of Colorado (CU), AHCA/NCAL offers an online educational program titled High Intensity Physical Rehabilitation in Medically Complex Populations. This program is offered through ahcancalED and is designed for physical therapy and occupational therapy rehabilitation professionals (PT, PTA, OT, OTA).   

The course presents an evidence-based approach for the implementation of a high intensity progressive rehabilitation model as part of an evolution from current lower intensity post-acute treatment approaches to address myriad patient needs. Rehabilitation professionals will have access to an interactive multimedia learning experience including responsive, self-paced presentation of foundational concepts, simulated case scenarios, and a moderated discussion environment for learning with fellow clinicians - all informed by the latest learning science and innovative technology.  

The goal of the course is to teach rehabilitation professionals better methods of addressing functional decline due to underlying medical complexity and deconditioning from hospitalizations or illness. By the end of this course, rehab professionals will learn how to:

  1. Screen all patients for safe participation in high intensity rehabilitation
  2. Establish an appropriate high intensity plan of care for eligible patients
  3. Execute effective and engaging rehabilitation sessions informed by high intensity rehabilitation strategies
  4. Perform ongoing monitoring of patient response to activity and adapt high intensity plans of care throughout the length of stay
  5. Communicate and document completely and efficiently to facilitate continuity of care
  6. Identify current gaps in care for older adults that high intensity rehabilitation can address and advocate for its use in the skilled nursing setting

This self-paced course contains nine learning modules. Each module has an interactive lesson. Some modules have quizzes, some have Slack channel discussions, and some have case simulations to test the mastery of the subject matter. The course concludes with the Post-Assessment/Final Exam and survey. All modules must be completed to take the Post-Assessment/Final Exam. 

CU recommends that the course be taken over an eight-week period to allow rehab professionals time to implement and practice the concepts as they are learned. Documentation will be provided by AHCA/NCAL to rehab professionals who successfully complete the course, so that they can apply to their respective state licensing boards for continuing education credits.  

The course fee is $495 for an employee or contracted employee registering as affiliated with an AHCA member facility and $595 for all other non-member registrants. Individuals will register and pay for the course through the ahcancalED platform at this web site: ahcancal.org/restoreregistration. Then, within 48 hours, registrants will receive further instructions on how to go to the CU platform and enroll in the course and begin their coursework.  

Individuals will need to login with their AHCA/NCAL usernames and passwords to register for this course. For assistance obtaining AHCA/NCAL usernames and passwords, individuals should e-mail educate@ahca.org with their name and facility contact information. Questions about the program should also be directed to educate@ahca.org.

AHCA and CMS Recommend Two Infections Preventionists for SNFs

Dave Kyllo

AHCA/NCAL’s expanded version of its popular Infection Preventionist Specialized Training (IPCO Version 2) is recommended for individuals responsible for infection prevention and control in all long term care settings.  

AHCA has long recommended that each skilled nursing facility train at least two Infection Preventionists through AHCA’s IPCO training program should one Infection Preventionist leave the facility or be unavailable. On a May 13 nationwide conference call for nursing homes, CMS also recommended that skilled nursing facilities have two Infection Preventionists for the same reasons. 

IPCO Version 2 is designed to train Infection Preventionists and is approved for 25 ANCC contact hours. The online course is also now approved for 22 NAB CEUs for Administrators. AHCA/NCAL recognizes Administrators will not serve as designated Infection Preventionists but recommends that Administrators consider taking the course to gain a deeper understanding of infection prevention and control in the overall operation of a nursing facility as this is a high target area for survey and liability.  

Phase III Requirements of Participation took effect November 28, 2019 and mandate that every nursing facility have a designated and specially trained Infection Preventionist who is running a comprehensive infection prevention and control program.  

IPCO Version 2 includes:

  • Updated regulatory requirements and added course content, including: 
    • Multi-drug Resistant Organisms (MDROs) and Enhanced Barrier Precautions (EBP)
    • Candida Auris
    • Water management
    • COVID-19

  • Bonus Content – All persons who register for IPCO Version 2 receive additional non-CE approved content. Topics include Interim COVID-19 Guidance, and courses on PPE and N-95 mask use.  

The registration fee is $450 for AHCA/NCAL members and $650 for non-members. There are no refunds and no transfers.  Registrants have one year to complete the course. Payment and registration are made online at ahcancalED. Discounted group purchase rates are available for groups of 25 or more by contacting educate@ahca.org.   

Note that while CDC/CMS does offer a free infection prevention training course, AHCA’s IPCO Version 2 training is far more comprehensive and includes updated information that is taught by experts with real-life practical long term care experience.  

Members will need to login with their AHCA/NCAL usernames and passwords to register for IPCO Version 2. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information. 

Monday, August 10, 2020

MACs Resume Medical Review on a Post-Payment Basis

Dan Ciolek

A few weeks ago AHCA alerted members that CMS was planning on resuming some medical review audit activities starting August 3. CMS also indicated that providers could request flexibilities from the audit contractors if they were currently challenged with the COVID-19 situation in their community. On August 6, CMS made the below clarification related to MAC-specific audits. If you experience MAC audit activities that are different than described below, please submit an email describing the situation to pdpm@ahca.org (please no privacy protected information).   

CMS Announcement:

“To protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities. Beginning August 17, the MACs are resuming with post-payment reviews of items/services provided before March 1, 2020. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The MACs will continue to offer detailed review decisions and ducation as appropriate.”


CMS Extends Date To Submit Updated ABN Form for Medicare Services

Dan Ciolek

On June 30, 2020 AHCA notified members that the Centers for Medicare and Medicaid Services (CMS) updated the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, which is issued by SNF and other providers submitting claims for Medicare items and services to beneficiaries in situations where Medicare payment is expected to be denied. The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances. Guidelines for issuing the ABN can be found beginning in Section 50 in the Medicare Claims Processing Manual, 100-4, Chapter 30. SNFs issue the ABN to transfer potential financial liability for items/services expected to be denied under Medicare Part B only. The updated ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The ABN form and instructions may be found here.

At that time, CMS indicated that the use of the renewed form with the expiration date of 06/30/2023 will be mandatory on 8/31/2020. However, CMS just announced that due to COVID-19 concerns, CMS has extended the deadline for use of the renewed ABN, Form CMS-R-131 (exp. 6/30/2023). At this time, the renewed ABN will be mandatory for use on 01/01/2021. The renewed form may be implemented prior to the mandatory deadline.  


Friday, August 7, 2020

CMS Clarifies National COVID-19 Training for Additional Funding

AHCA/NCAL inquired with CMS again this week to clarify the National CMS/CDC COVID-19 Training requirements for additional funding via Provider Relief Fund Program. CMS again stated that this training is not yet available. The CMS/CDC COVID-19 Training requirement for the Provider Relief Fund program is a separate, online training which will be in the format of an on-demand module that will be released in the near future (potentially September). Although this training is not yet launched, once the details are finalized, CMS will make a formal announcement. 

CMS also clarified why they are collecting CCNs for the current weekly QIN/QIO infection control trainings. According to CMS, they are requesting that nursing homes provide their CCN in order to track attendance for the weekly National CDC/CMS COVID-19 trainings presented by the QIN/QIOs for the purpose of providing recognition badges to nursing homes for attending these trainings. For clarification, this is not the training referred to in the Provider Relief Fund Program announcement.

Wednesday, August 5, 2020

Now Available! The NALW 2020 Planning Guide & Product Catalog

Time to start planning for National Assisted Living Week® (September 13-19, 2020) with this year’s Planning Guide and Product Catalog. The planning guide offers ideas to help your residents stay connected, improve your assisted living community, and honor your staff. All suggested activities and official products highlight this year’s theme, “Caring is Essential.” 

The theme recognizes that COVID has been an enormous, unforeseen challenge that has resulted in every person working in long term care to step up and go above and beyond expectations. At a time when the entire profession is doing so much, this year’s NALW theme reflects the hard work and dedication of all the essential caregivers in assisted living facilities across the country.

Some of the suggested activities include: 
  • Celebrate the end of summer with special ice cream deliveries for residents and staff.
  • Organize a family drive-by caravan and live outdoor performances, as well as contests, raffles, and hallway games.
  • Combat social isolation among your residents by encouraging connections with their families and loved ones via outdoor or window visits (depending on your state’s guidelines).
  • Have residents share a special meal together with family or friends via Zoom or FaceTime, and look at photos and reminisce over happy family events. 
  • Encourage loved ones or members of the community to write notes or upload drawings and video messages of support and love for residents and messages of gratitude for staff.
  • Provide lyrics and sheet music for a community hallway singalong.
  • Share your own activity ideas on the NALW Facebook page
The guide also connects providers to this year’s NALW official products, which can also be found in AHCA/NCAL’s online bookstore. Show your support for your staff and residents! 

Looking to create your own materials? The NALW website (www.NALW.org) offers this year’s logo in a variety of formats available for download. Please make sure to follow our logo policy: 

Download the logo in various formats for online use as well as professional print products. You may use the following files, intact, to promote National Assisted Living Week 2020. All other rights, including the creation of derivative works, are reserved by the National Center for Assisted Living. 

Stay tuned for a forthcoming media toolkit to help assisted living providers promote NALW in their community. 

For more information, please visit www.NALW.org.

CMS Issues FY 2021 SNF Final Payment Rule

The Centers for Medicare & Medicaid Services (CMS) today issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2021 update.   

We are pleased to report that the final rule includes a net market basket increase of 2.2 percent. The final market basket is one tenth lower than the proposed market basket of 2.3 percent due to updated data reflecting substantial changes in the macroeconomic forecast due to COVID-19 CMS estimates that the net market basket update would increase Medicare SNF payments by approximately $750 million in FY 2021.

As we predicted, CMS issued the final rule with few changes in the Patient-Driven Payment Model (PDPM) payment policy section. Updates were limited to nominal additions/deletions of ICD-10 codes used to map the primary reason for SNF stay diagnosis to appropriate PDPM clinical categories from the lists included in the proposed rule. 

The team at AHCA team has developed a summary (member login required) of the payment updates, the SNF value-based purchasing program, and the IMPACT Act quality reporting additions.  

Tuesday, August 4, 2020

AHCA/NCAL Announces a Trio of Exciting General Session Speakers for October’s Virtual Convention & Expo


This year’s Convention & Expo has the right speakers for the times.

On Thursday, October 8, Captain Scott Kelly and presidential historian Doris Kearns Goodwin will kick off convention with messages of recognition and support of the herculean effort each of you have shown throughout the pandemic. 

Captain Kelly is the history-making astronaut, retired U.S. Navy officer, and best-selling author of Endurance: My Year in Space, A Lifetime of Discovery. He understands what it means to “choose to do the hard things.” With awe-inspiring stories from space and personal reflections on leadership, teamwork, and testing limits, Captain Kelly inspires others to believe that they can reach any goal, no matter how ambitious or audacious.



Doris Kearns Goodwin is a world-renowned presidential historian, public speaker and New York Times #1 best-selling author. She was awarded the Pulitzer Prize for No Ordinary Time: Franklin and Eleanor Roosevelt: The Home Front in World War II, and her most recent book, Leadership in Turbulent Times, was published to critical acclaim and became an instant bestseller. The book provides an accessible and essential road map for aspiring and established leaders in every field, and for all of us in our everyday lives. She will offer insights and perspectives applicable to the challenges we face today.




On Thursday October 22, Kindra Hall, President and Chief Storytelling Officer at Steller Collective, will speak on how to better communicate the value of your company, your products, and your individuality through strategic storytelling. A best-selling author and award-winning columnist, her message is sure to resonate and provide inspiration and ideas as you process the difficult and moving events of the past year.







These unique speakers are just three of the many wonderful people who will be making the 2020 Virtual Convention & Expo memorable and meaningful. Find out more about all that’s happening from October 8th through October 31st at AHCAConvention.org. With 24 full days of on-demand and live sessions, you’ll find everything you need and then some.


AHCA/NCAL’s Affordable Online Water Management Training is Ideal for All Building Operations Staff


Skilled nursing and assisted living centers provide care for vulnerable people who can become critically ill when steps are not taken to reduce the risk of waterborne diseases such as Legionnaire’s. Effective water management programs are mandated for nursing facilities by CMS and highly recommended for assisted living facilities by the Centers for Disease Control and Prevention as a best practice.
 
AHCA/NCAL offers an affordable online Water Management Training course that provides long term care staff with information about:  
  • what a water management plan is; 
  • the essential elements of an effective water management program; and, 
  • how nursing and assisted living facilities should develop and maintain comprehensive water management programs. 
The online one-hour training contains five modules and is designed for administrators, building engineers and maintenance department personnel, DONs who have not been trained as Infection Preventionists, and other staff responsible for building operations or infection prevention and control.
 
The per-individual cost for the training is $25 for AHCA/NCAL member facility staff and $65 for non-members. An online final test and certificate of completion are included with each registration.

Make sure your facility is ready to address the threat of water-borne pathogens and external water interruptions by having a thorough and effective water management plan in place. Register for AHCA/NCAL’s Water Management Training today.  

Check Out this 45-Minute Webinar Filled with Helpful Workforce Recruitment and Retention Strategies


AHCA/NCAL offers an instructional webinar titled “Pioneering Solutions to the Workforce Crisis.” This 45-minute webinar developed in collaboration with PHI delivers practical action steps and strategies assisted living and nursing facilities of all shapes and sizes can take to improve their employee and retention efforts. The webinar also covers ways to improve the hiring process and explains supportive supervision and coaching methods that positively impact employee retention.  

The webinar’s learning objectives include:
  1. Explain the key factors contributing to the workforce shortage
  2. Identify at least 3 strategies to improve employee recruitment
  3. Identify at least 3 strategies to improve employee retention
  4. Explain the impact of supportive supervision on retention
This webinar is part one to a more extensive on-line training for middle managers that will be released in the coming months. While no CEUs are offered for this webinar, participants can receive a certificate of completion. The cost of the course is $25 for AHCA/NCAL members and $60 for non-members.  

The instructor is Sue Misiorski who served as Vice President of Workforce Innovations for PHI and currently serves as the New England Regional Director of Operations for SageLife. Starting as a CNA, she later held positions as a DON and VP of Nursing in multi-site skilled nursing homes in New England and has supported the construction of several assisted living and nursing facilities. Follow this link to read more about this educational webinar and to register for the course.

To access ahcancalED and the Pioneering Solutions webinar, members will need to login with their AHCA/NCAL usernames and passwords. For assistance obtaining AHCA/NCAL usernames and passwords, individuals should e-mail educate@ahca.org with their name and facility contact information

Learn the Fundamentals of Population Health Management through this Exclusive Resource Created for AHCA/NCAL Members


AHCA/NCAL recently launched the first phase of its Population Health Management (PHM) Innovation Lab. Phase I contains free “AHCA/NCAL Member Only” foundational resources designed to introduce AHCA/NCAL assisted living, nursing facility and intermediate care facility members and their staff to the wide array of PHM models available today and in the future. 

Phase I PHM Innovation Lab resources are ideal for familiarizing owners, operators, administrators and LTC managers about the fundamentals of various PHM models and how these models can better serve LTC organizations, residents and families. Members can also access the PHM Innovation Lab resources at: PHMInnovationLab.com

CMS continues to drive the healthcare system to one of value by shifting financial risk to providers through a range of fee-for-service (FFS) and managed care models. PHM is the application of interventions and strategies to improve the health outcomes and manage the costs of a targeted group.  PHM models vary based on the degree of risk, degree to which payments are tied to quality, reliance on data analytics and level of care coordination. Understanding these models is vital in today’s operating environment.

Historically, PHM models have been led by hospitals, health systems, physician groups and large insurance organizations. In recent years, LTC providers (including assisted living) and PAC providers have assumed leadership roles in developing and employing several PHM models. The new environment demands new models, and PHM helps LTC/PAC providers understand and integrate new strategies into SNF and AL buildings by integrating SNF/AL and primary care, enhancing care transitions, and using robust care management models.

PHM models have evolved to address targeted groups of individuals (SNF and AL residents in our case), to improve their health outcomes, and providers can use these models to drive better outcomes, strategies and interventions for handling the COVID-19 crisis. A PHM model, provider led Special Needs Plans (SNPs) can be an important solution in the current COVID-19 environment. With the deployment of on-site nurse practitioners providing primary care at the long term care bedside, costly and potentially dangerous hospital transfers can be avoided. 

The PHM Innovation Lab Phase I contains six different subject area modules with corresponding educational components including webinars and briefs.  
  1. Population Health Management Fundamentals -- Describes the who, what, where, and how of Population Health Management (PHM). It also introduces various PHM models including their specific characteristics, benefits, and implications.  

  2. Accountable Care Organizations -- Provides an overview of the structure, financial model, and regulatory requirements of different ACOs. Types of ACOs covered include Medicare Shared Savings Programs and Next Generation ACOs.  

  3. Bundled Payments -- Provides an overview of the basics of bundled payments (episode-based payments) including what are bundled payments, how they work, and their implications for LTC and PAC providers.  

  4. Emerging Models: Direct Contracting -- Provides a detailed overview of Direct Contracting including types of participants, payment, beneficiary alignment, quality incentives, and a model timeline.  

  5. Managed Care -- Provides an overview of Medicare Advantage/ Provider-led Special Needs Plans (SNPs) and explains how SNPs work, and discusses the implications for LTC and PAC providers.  

  6. Provider Networks --Provides an overview of the why, what, and how of provider-owned integrated care networks and explains the benefits of provider networks.  
Members will need to login with their AHCA/NCAL usernames and passwords to access PHM Innovation Lab materials. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information.  

Monday, August 3, 2020

Providers May be Due Refunds from Physicians for Some Services Excluded from SNF Consolidated Billing

On July 31, the Centers for Medicare and Medicaid Services (CMS) issued a notice that three new telephone evaluation and management codes were added to the list of physician services excluded from SNF Part A consolidated billing (CB) and therefore payable to the physician by the Medicare Administrative Contractor (MAC). In some cases, the Medicare claims processing edits inaccurately denied the services citing CB, and the physician subsequently billed the SNF instead. This problem edit has been corrected. Provider business offices should review the following details to determine if a refund is due from any physician offices. 

Specifically, the current COVID-19 Public Health Emergency (PHE) does not waive any requirements related to SNF CB; however, CMS added CPT codes 99441, 99442, and 99443, to the list of telehealth codes coverable under the waiver during the PHE. These codes designate three different time increments of telephone evaluation and management service provided by a physician. The physician can bill for these physician services separately under Part B when furnished to a SNF’s Part A resident.

The MACs have been instructed to reprocess claims for CPT codes 99441, 99442 and 99443 with dates of service on or after March 1, 2020, that were denied due to SNF CB edits. Physicians will have their Medicare claims automatically adjusted. If the physician office instead billed the SNF for these services citing CB, they are required to refund the payment to the SNF.

For more information, please visit www.ahcancal.org/coronavirus or email COVID19@ahca.org

Saturday, August 1, 2020

HHS Provider Relief Fund Announcements

On July 31, the U.S. Department of Health and Human Services (HHS) announced three new approaches to securing funding: 
  • The Medicaid allocation application has been extended to August 28, 2020. 
  • For certain Medicare providers, HHS will allow those providers who missed the opportunity to apply for additional funding from the $20 billion portion of the $50 billion Phase 1 Medicare General Distribution. The opportunity to apply will begin on August 10 and will close on August 28. 
Payments for Providers Who Had a Change in Ownership

Also starting the week of August 10, providers who experienced challenges receiving Provider Relief Fund payments due to change in ownership may submit their revenue information, along with documentation proving a change in ownership, for consideration for Provider Relief Fund payment. HHS has said it will accept this information through August 28.

Read the full press release.