The following provider enrollment flexibilities are implemented: 

• Temporarily suspends certain Medicare enrollment screening requirements for non-certified Part B suppliers, physicians, and non-physician practitioners. This includes waiver of the application fee, criminal background check, and site visits. 
• Postpones all revalidation actions. 
• Expedites any pending or new applications. 
• Establishes a toll-free hotline for providers to enroll and receive temporary Medicare billing privileges. Hotlines are specific to each Medicare Administrative Contractor (MAC); click here to locate your hotline number. 
• Allows practitioners to render telehealth services from their home without updating their Medicare enrollment information with their home address. 

 

Allows licensed providers to render services outside their state of enrollment for purposes of billing Medicare and Medicaid if the following conditions are met: 

1. the physician or nonphysician practitioner must be enrolled as such in the Medicare program;
2. the physician or nonphysician practitioner must possess a valid license to practice in the state which relates to his or her Medicare enrollment;
3. the physician or non-physician practitioner is furnishing services – whether in person or via telehealth – in a State in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity; and  
4. the physician or non-physician practitioner is not affirmatively excluded from practice in the state or any other state that is part of the 1135 emergency area.  

This waiver does not have the effect of waiving state or local licensure requirements or any requirement specified by the state or a local government. These will continue to apply unless waived by the state. Therefore, in order for the physician or non-physician practitioner to avail him- or herself of the enrollment waiver under the conditions described above, the applicable State must also waive its licensure requirements. A physician or non-physician practitioner may seek a licensure waiver from CMS by contacting the Medicare Provider Enrollment Hotline for the MAC that services their geographic area. 

 

In general, during the PHE, direct supervision is defined as a virtual presence through the use of interactive telecommunications technology, for services paid under the PFS, as well as for hospital outpatient services. The revised definition of direct supervision also applies to pulmonary, cardiac, and intensive cardiac rehabilitation services during the PHE. Additionally, CMS changed the supervision requirements from direct supervision to general supervision, and to allow general supervision throughout hospital outpatient non-surgical extended duration therapeutic services. Most other therapeutic hospital outpatient services have been subject to general, rather than direct, supervision requirements since January 1, 2020. General supervision means that the procedure is furnished under the physician’s overall direction and control, but that the physician’s presence is not required during the performance of the procedure. General supervision may also include a virtual presence through the use of telecommunications technology but we would note that even in the absence of the PHE general supervision could be conducted virtually, such as by audio-only telephone or text messaging. 
 

CMS is modifying the 60-day limit in locum tenens regulations to allow a physician or physical therapist to use the same substitute for the entire time he or she is unavailable to provide services during the COVID-19 emergency, plus an additional period of no more than 60 continuous days after the public health emergency expires. Without this flexibility, the regular physician or physical therapist generally could not use a single substitute for a continuous period of longer than 60 days and would instead be required to secure a series of substitutes to cover sequential 60-day periods.

HHS announced it is suspending most Medicare Fee-For-Service (FFS) medical reviews during the emergency period due to the COVID-19 pandemic. This includes pre-payment medical reviews conducted by MACs under the Targeted Probe and Educate (TPE) program and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractors, and/or Recovery Audit Contractors (RACs). No additional documentation requests will be issued for the duration of the PHE for the COVID-19 pandemic. This suspension of medical review activities is for the duration of the public health emergency however CMS may conduct medical reviews during or after the emergency if there is an indication of potential fraud. 

CMS implemented waivers that exempt providers from sanctions for noncompliance of certain Stark Law rules, permitting certain referrals and the submission of related claims that would otherwise violate the Stark Law.
 

Visit the MGMA APM webpage for more information and the latest news on APMs during COVID-19.
 

(Download MGMA's PPP resource for more information.)

Following legislation signed into law on Dec. 27, 2020, borrowers can now apply for First and Second Draw PPP loans through May 31, 2021 or until funding is exhausted.

Small businesses, sole proprietors, independent contractors, gig economy workers, and selfemployed individuals are eligible. For purposes of this program, small businesses are defined as 500 or
less employees unless the industry has an employee-based size standard provided by the SBA that is
greater than 500 employees. 501(c)(3) and 501(c)(19) organizations with fewer than 500 employees are
eligible as well. Following the passage of the Economic Aid Act, 501(c)(6) organizations with 300
employees or less can qualify as borrowers if they meet certain criteria regarding lobbying activities. SBA notes that even if a borrower meets these requirements, they may be ineligible for certain reasons such as the business was not in operation on Feb. 15, 2020, a member of the executive or legislative branch holds a controlling interest in the business, or your business is permanently closed and has no intention of reopening from receiving a PPP loan.

The Provider Relief Fund Reporting Portal is now open for registration only.

Congress and the Administration have recognized that the Stark Law and other fraud and abuse rules stand in the way of value-based payment reform. Efforts to update the Stark Law have been centered around scaling it back for those that participate in alternative payment models, risk-based contracting, or value-based arrangements. Unfortunately, policymakers have not meaningfully addressed the law’s complexity or overarching burden outside of the value-based space. CMS proposed a rule in October 2019 amending the Stark Law, in particular adding new exceptions for value-based arrangements. MGMA strongly supported this proposal and offered feedback on other provisions. CMS says a final rule will be coming in 2020, but there is no deadline for finalizing proposals. 

The in-office ancillary services exception is critical to group practices that offer ancillary services. This exception has not been significantly changed or addressed in recent years. To voice your support for maintaining this exception, visit our Contact Congress portal to send a letter to your representatives.

 

Not currently, as this is something that only Congress can do. CMS does not have a statutory authority to do it. There is legislation that proposes eliminating coinsurance, but there are still legislative hurdles to get that passed and enacted.

Help MGMA advocate for this legislation! Use our Contact Congress portal to reach out to your member of Congress and request their support for this legislation.

 

Medicare claims must be submitted with the new Medicare Beneficiary Identifier (MBI) starting Jan. 1, 2020. Claims without an MBI will be rejected. If patients do not present with their new Medicare card, which contains the MBI, you can access the MBI through your Medicare Administrative Contractor web portal. For more information, download the member-benefit New Medicare Card Toolkit.

 

The Office for Civil Rights (OCR), the government agency responsible for oversight and enforcement of HIPAA Privacy and Security, recently issued guidance to assist physician practices and others better understand the new environment of Application software (better known as “APPs”). Increasingly, EHRs have the capability of supporting practice and patient use of APPs to capture and use electronic protected health information (ePHI). There are, however, significant privacy and security implications as practices and their patients seek to leverage this new technology. With this guidance, OCR provides much needed clarification to practices (and other covered entities) deploying APP technology or releasing information to patient-designated APPs. Download the MGMA toolkit to guide your practice through the use of apps.

 

The Affordable Care Act required HHS to issue standards and operating rules for electronic funds transfer (EFT) payments from health plans to providers. The regulations, which went into effect in 2014, mandated that the health plan MUST issue payments via EFT when requested by the provider. Even with these regulations, MGMA has seen plans issue payments in the form of "virtual" credit cards, deny reimbursement in the form of paper checks while practices enroll in EFT, and also assigned a percentage fee for the EFT transaction for practices that do enroll.

MGMA advocated for CMS to curb these unfair business, reiterating that providers had to be paid via EFT when they requested this method, and address other key payment issues. As a reminder, plans must offer payment via EFT when requested by the provider. MGMA has developed an EFT guide and sample EFT request letter to assist members receive their payments quickly and fairly. If a practice finds that a plan is not abiding by these rules, a formal complaint can be filed through the CMS Administrative Simplification Enforcement and Testing Tool webpage.

 

The AUC program was mandated under the Protecting Access to Medicare Act of 2014 and requires professionals ordering certain advanced imaging tests for Medicare patients to consult a quality Clinical Decision Support Mechanism (CDSM) to establish the test's appropriateness for the patient's condition. The rendering professional will be required to include the AUC consultation code on their Medicare claim.

Starting in Jan. 2020, CMS will begin an education and operational testing period, which is intended practices time to prepare and test systems. Starting in Jan. 2022, Medicare claims that do not include the CDSM consultation code will be rejected.

MGMA Government Affairs has developed this toolkit to help practices understand and implement the requirements of the AUC program. 

 

Calendar year 2020 is an educational and operations testing period for the AUC program. Therefore, there are no payment consequence associated with the program this year. However, CMS encourages practices to learn, test, and prepare for 2021, when failure to comply with the program will result in rejected claims. For help understanding and implementing the AUC program, please download MGMA’s AUC Toolkit.

Following MGMA advocacy efforts to expand access to virtual care, the Centers for Medicare & Medicaid Services (CMS) created new codes for communications-based technology services starting Jan. 1, 2019. Newly covered services include a virtual visit (i.e., a brief 5-10 minute check-in via telephone), interpretation of patient-submitted images and videos, remote patient monitoring, and interprofessional consultations. MGMA Government Affairs developed at member-exclusive analysis that outlines these new technology codes including the billing requirements, code descriptions, qualifying technologies and more.