Knowledge Expansion

MGMA COVID-19 Action Center

Insight Article

Disaster Planning

Policies & Procedures

Medicare Payment Policies

As the country works to combat the spread of Coronavirus Disease 2019 (COVID-19), MGMA will keep medical group practices apprised of the latest developments that could affect patient care and practice operations. Guidance for healthcare providers from the Centers for Disease Control and Prevention (CDC) is available here. The COVID-19 Action Center is routinely updated as new information is made available. For a topical list of resources, please visit the MGMA COVID-19 Resources Center. 

 

March 27, 2020

Congress passes the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act

  • MGMA statement on emergency funding for medical practices.
  • MGMA publishes a high level summary of key provisions in the law that affect medical groups.
  • MGMA calls on HHS to immediately begin financial support of medical groups.
  • MGMA urges HHS to further waive telehealth restrictions following CARES Act.


March 26, 2020

CMS releases FAQs on COVID-19 Medicare Provider Enrollment Relief.


March 24, 2020

OIG releases FAQs on policy regarding physicians and other practitioners reducing or waiving beneficiary cost sharing for telehealth services during COVID-19.


March 23, 2020

MGMA Advocacy

Urge Congress to support physician practices during COVID-19

As Congress works to pass additional emergency funding legislation to combat COVID-19, your help is needed to support medical practices during this public health emergency. Use MGMA's draft letter to ask Congress to:
  • Ensure that every physician and healthcare worker has access to critically needed personal protective equipment (PPE);
  • Provide direct financial support to medical practices experiencing an adverse economic impact from suspending visits and procedures unrelated to COVID-19;
  • Provide direct financial support to medical practices on the front lines of the COVID-19 public health emergency; and
  • Require all payers to provide coverage and payment for telehealth visits (including audio-only) at the same reimbursement as in-person visits.

To send your letter to Congress, click here

Also, MGMA joins coalition urging Congress to leverage health IT during COVID-19 emergency.


March 22, 2020

Provider enrollment and Quality Reporting changes

  • CMS releases FAQs on Medicare Provider Enrollment Relief related to COVID-19 including the toll-free hotlines available to provide expedited enrollment and answer questions related to COVID-19 enrollment requirements.
  • CMS announces relief for providers participating in quality reporting programs in response to COVID-19.
    • The 2019 MIPS data submission deadline extended from March 31, 2020 to April 30, 2020.
    • MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year.
 

March 20, 2020

MGMA Advocacy

MGMA joins coalition calling on Congress to ensure sustainability of physician practices during COVID-19 emergency. 


March 18, 2020

Families First Coronavirus Response Act

The Families First Coronavirus Response Act was signed into law, which requires employers to provide employees with paid FMLA and sick time under certain circumstances. 

Both new Sick and FMLA rules:
  • Are effective within 15 days. 
  • Apply to employers with fewer than 500 employees.
  • Include exceptions to their respective requirements for: 
    • An employer of an employee who is a healthcare provider or an emergency responder may elect to exclude those employees, and
    • Two additional exceptions designated in forthcoming regulations under the Department of Labor.

Paid FMLA Leave for “Public Health Emergency”
  • Creates a new category of FMLA-covered leave for up to 12 weeks of job-protected leave for employees unable to work (or telework) due to the need to care for his or her child (under 18 years) if their school or daycare has been closed due to a public health emergency. Leave under this category makes employees eligible.
  • Payment during new category of leave:
    • The first 10 days of leave is not paid and the employee is allowed to substitute any accrued vacation, personal or medical/sick leave for unpaid leave.
      After the first ten days, the employer must provide the employee no less than two-thirds of the employee’s usual pay, capped at $200/day ($10,000 aggregate).
Tax credit for employers: Provides a refundable tax credit equal to 100% of qualified family leave wages paid by an employer for each calendar quarter, capped at $200/day and $10,000 for all calendar quarters.


Emergency Paid Sick Leave
  • Covered employers must make up to 80 hours of paid sick leave available for certain Coronavirus-related absences, in addition to any current paid time off provided by the employer.
  • Reasons for sick leave:
    1. Employee is subject to federal, state or local quarantine or isolation order
    2. Employee has be advised by healthcare provider to self-quarantine 
    3. Employee is experiencing COVID-19 symptoms and seeking medical diagnosis
    4. Employee is caring for individual who is subject to order described in #1 above
    5. Employee is caring for his or her child if school or place of care is closed due to COVID-19 precautions
    6. Employee is experiencing nay other substantially similar condition specified by Secretary of Labor
  • Payment during sick leave:
    • For sick leave under reasons 1-3 (e.g., employee is sick), leave is paid at the employee’s regular rate of pay, capped at $511 per day ($5,110 aggregate). 
      For sick leave under reasons 4-6 (e.g., employee is caring for someone else), leave is capped at $200/day ($2,00 aggregate).
Tax credit for employers: Provides a refundable tax credit equal to 100% of qualified paid sick leave wages paid by an employer for each calendar quarter. 


CMS recommends delaying electives / MGMA advocacy

  • CMS releases COVID-19 elective surgeries and non-essential procedures recommendations; press release
  • MGMA releases guidance on new Medicare telehealth waivers
  • MGMA urges Congress to provide direct financial assistance to group practices and take further action on COVID-19
  • MGMA joins coalition calling on Senate to ensure access to Medicare value based care during COVID-19 pandemic
  • MGMA joins coalition calling on CMS to allow flexibilities for QPP-participating clinicians
  • MGMA joins coalition calling on House to ensure access to Medicare value based care during COVID-19 pandemic


March 17, 2020

Medicare Telehealth Waivers

The Centers for Medicare and Medicaid Services (CMS) issued guidance on Secretary Azar’s waiver authority that broadens access to Medicare telehealth services. Effective March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, CMS will:

  • Waive geographic restrictions, meaning patients can receive telehealth services in non-rural areas;
  • Waive originating site restrictions, meaning patients can receive telehealth services in their home;
  • Allow use of telephones that have audio and video capabilities; 
  • Allow reimbursement for any telehealth covered code, even if unrelated to COVID-19 diagnosis, screening, or treatment; and
  • Not enforce the established relationship requirement that a patient see a provider within the last three years.

Guidance and Resources
  • MGMA releases guidance on new Medicare telehealth waivers
  • CMS releases General Provider Telehealth and Telemedicine Tool Kit
  • CMS has releases FAQs outlining the new Medicare telehealth waiver.
  • OCR releases notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency.
  • CMS releases Medicaid fee-for-service telehealth guidance. 


March 16, 2020

Medicare Fee-for-Service (FFS) response to the public health emergency on the Coronavirus. Although Secretary Azar authorized waivers and modifications under Section 1135 of the Social Security Act (the Act) on March 13, 2020, they are retroactive to March 1, 2020.


March 15, 2020

Secretary Azar exercises authority to waive sanctions and penalties against covered hospitals that do not comply with certain provisions of the HIPAA Privacy Rule.


March 13, 2020

National Emergency Declared

President Trump declares a national emergency, which expands HHS’ abilities to issue blanket waivers regarding Medicare, Medicaid, and CHIP program requirements. Waivers implemented as of this date include:
  • Provider Enrollment Flexibilities. CMS will:
    • Allow licensed providers to render services outside their state of enrollment for purposes of billing Medicare and Medicaid, so long as the provider is licensed in another state. This does not waive state licensing requirements for purposes of billing health programs regulated at the state level.
    • Temporarily suspend 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. It postpones all revalidation actions and expedites any pending or new applications.
    • Establish a toll-free hotline for providers to enroll and receive temporary Medicare billing privileges.
  • Skilled Nursing Facilities (SNF). CMS will:
    • Waive the requirement for a 3-day prior hospitalization prior to coverage of a SNF stay in order to provide temporary emergency coverage of SNF services without a qualifying hospital stay for those people who need to be transferred as a result of the effect of a disaster or emergency. 
    • For certain beneficiaries who recently exhausted their SNF benefits, CMS will authorizes renewed SNF coverage without first having to start a new benefit period. 
    • Waive requirements under 42 CFR 483.20 to provides relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission.
  • Durable medical equipment (DME) and prosthetics, orthotics, and supplies (POS). CMS will:
    • For DMEPOS that is lost, destroyed, or otherwise unusable, contractors may waive replacement requirements such as: a face-to-face visit, obtaining new order from a physician, and new medical necessity documentation. 
  • Medicare Appeals for Parts B, C, and D. CMS will:
    • Extend timeline to file an appeal.
    • Waive timelines for requests for additional information to adjudicate an appeal.
    • Process requests for appeal using information available even when requests do not meet required elements.
    • Utilize all flexibilities available in appeals process as if good cause requirements are satisfied.
CMS releases COVID-19 guidance for nursing homes.


March 12, 2020

  • CMS releases COVID-19 FAQs for State Medicaid and CHIP Agencies.
  • CMS posts COVID-19 test pricing fact sheet for Medicare Administrative Contractors (MACs)
  • CMS posts FAQs on Essential Health Benefit Coverage and the Coronavirus


March 11, 2020

  • MGMA urges HHS to exercise telehealth waiver authority
  • Congressional telehealth caucus urges HHS to expeditiously exercise the telehealth waiver authority
  • IRS issues guidance regarding high-deductible health plans and expenses related to COVID-19.
  • FDA’s notice to healthcare providers on surgical mask and gown conservation strategies 


March 10, 2020

CMS issues guidance to Medicare Advantage Organizations, Part B sponsors, and Medicare-Medicaid plans regarding COVID-19.


March 9, 2020

  • CMS issues guidance on screening, treatment, and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of COVID-19 in a hospice setting. CMS also released additional guidance specific to helping nursing homes control and prevent the spread of the virus.
  • CMS publishes guidance for hospitals with emergency departments on patient screening, treatment, and transfer requirements to prevent the spread of COVID-19 and other infectious diseases.


March 6, 2020

Emergency funding bill signed into law

  • President Donald Trump signed into law an $8.3-billion emergency funding bill that passed Congress with bipartisan support to aid in containing coronavirus and treating its associated illness. The Coronavirus Preparedness and Response Supplemental Appropriations Act includes a provision to allow the Secretary of the Department of Health & Human Services (HHS) to waive certain Medicare telehealth restrictions during the coronavirus public emergency. MGMA Government Affairs will continue to monitor and report on this issue as it develops, including when and how the telehealth waiver will be implemented.
  • CMS releases FAQs for healthcare providers regarding Medicare payment for laboratory tests and other services related to COVID-19.


March 5, 2020

Part B to cover COVID-19

  • CMS announces that Medicare Part B will cover tests for COVID-19 ordered by doctors or other healthcare providers and performed on or after Feb. 4, 2020. However, providers must wait until April 1, 2020 to submit claims to Medicare for the test.
  • CDC COVID-19 webinar: "What Clinicians Need to Know to Prepare for COVID-19 in the United States."  


March 4, 2020

CMS announces “Action to Address Spread of Coronavirus,” which includes issuing guidance to help State Survey Agencies and Accrediting Organizations prioritize inspections of healthcare facilities to focus exclusively on issues related to infection control and other serious threats to safety and health.


Feb. 13, 2020

CMS issues new HCPCS code for healthcare providers and laboratories to test patients for COVID-19 using the new CDC-developed test.


Feb. 6, 2020

CMS issues memo to assist healthcare facilities preparing for COVID-19.


Jan. 30, 2020

Following the Jan. 30 declaration by the World Health Organization (WHO) of coronavirus as a “public health emergency of international concern,” a new ICD-10 emergency code — U07.1, 2019-nCoV acute respiratory disease — was established. According to the CDC, a new diagnosis code based on the emergency code will be implemented, effective Oct. 1, 2020.

 

A special MGMA Insights podcast series on COVID-19

  • Episode 1: An action plan for medical practices and healthcare professionals
  • Episode 2: 'COVID-19 has pretty much taken over my life’: A practice administrator’s perspective
  • Episode 3: How one of Northern California’s largest health systems is responding to the crisis
  • Episode 4: What healthcare leaders need to know about telehealth and the CMS policy changes
  • Episode 5: Flattening the curve for America's elderly patients through quarantine and isolation
  • Episode 6: Did the healthcare system let down providers fighting on the front line?


Additional Resources:

CMS Guidance
CDC Guidance
Other Resources
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