CMS Revises Medicare Reimbursement Rate for COVID-19 Testing
Friday, October 30th, 2020

According to a recent announcement, CMS will decrease the base Medicare reimbursement rate for COVID-19 studies conducted by laboratories making use of high throughput technology. The announcement made late last week declared that, according to the revised Administrative Ruling (CMS-2020-1-R2), the rate would decrease to $75 from $100 starting in 2021.

At the height of the COVID-19 pandemic, CMS had increased the Medicare payment limit for high throughput COVID-19 research from about $51 to $100. However, should labs complete COVID-19 experiments within two calendar dates of the specimen being obtained, labs will be eligible to charge at the higher cost of $100, the regulation also specified.

Under the modified rule, labs using high-throughput COVID-19 research technology must have the ability to complete diagnostic tests within a pair of calendar days or less in order to apply for the higher reimbursement rate. This applies to the majority of patients versus solely those under Medicare.

The new Medicare payment rates are designed to encourage quicker, high-throughput research that will allow patients and clinicians to respond rapidly and resolutely with regard to their options for treatment, contact tracing, and more. Using an automated method that can administer more than 200 daily, high-throughput technologies allow improved testing power.

Laboratories would need to utilize the Healthcare Common Procedure Coding System (HCPCS) code U0005 to obtain a higher reimbursement rate and meet revised coding guidelines, which were also issued last week.

To read more, please visit https://revcycleintelligence.com/news/cms-reduces-medicare-reimbursement-rate-for-some-covid-19-tests.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

CMS Guidelines Promote Value-Based Medicaid Payments
Monday, October 26th, 2020

Recently, CMS provided guidelines to assist states with increasing the acceptance of a value based system through their Medicaid programs. The organization has pledged to promote value-based care within Medicare and is encouraging states to make similar attempts to make the same promotion through their Medicaid services. Medicare, Medicaid, and commercial providers overlap greatly. The guidance emphasizes the value of multi-payer alignment in assuring value-based care moves toward the conversion of the healthcare delivery system.

The guidelines include a host of additional concerns Medicaid directors may need to address, including how ready the delivery system is, stakeholder involvement, and financial uncertainty for providers. It also explains how states may utilize their current leverage in their Medicaid systems to implement value-based payments, including with managed care and Medicaid fee-for-service.

Numerous politicians and healthcare authorities have long supported widespread acceptance of value-based payments, which connect financial incentives from providers to the quality of treatment they offer to their patients. Per the Health Care Payment Learning and Action Network, roughly a third of healthcare payments were value-based in 2018.

To read more, please visit https://www.modernhealthcare.com/transformation/new-cms-guidance-encourages-value-based-payment-medicaid.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Worries About the Medicare Physician Fee Schedule Rule for 2021
Wednesday, October 21st, 2020

Provider organizations are worried certain proposals in the 2021 Medicare Provider Fee Schedule regulation will worsen the financial difficulties doctors are currently experiencing during the COVID-19 pandemic, including the inadequacy of sufficient payment for telehealth and profits from sustainable practice. The legislation released in early August suggested several improvements to next year’s Medicare Physician Fee Plan, including steep rate increases for certain specialties, improvements to the list of telehealth services, and additional standards for accuracy monitoring.

Increasing relative value units (RVUs) and payment for primary care facilities and treatment of chronic disorders are the key proposals of the rule. However, the regulation also requires a drop in the payment exchange factor to $32.26 from $36.09 in order to offset the improvements to RVUs for the services.

Provider industry groups have encouraged CMS to beef up telehealth scope recommendations in the finalized version of next year’s Medicare Physician Fee Schedule. Several proposals that would increase telehealth coverage were included in the rule, including the inclusion of eight codes to the Category 1 list of telehealth providers and the development of a separate Category 3 list to extend provisional coverage.

Another leading issue affecting multiple provider groups was the tweak to quality reporting regarding the Quality Payment Program and other value-based reimbursement models. The substitution of the APM Scoring Standard with the current Alternative Payment Model Efficiency Pathway was largely opposed, particularly by provider groups.

To read more, please visit https://revcycleintelligence.com/news/top-3-concerns-with-the-2021-medicare-physician-fee-schedule-rule.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

CMS Releases 2021 Medicare Advantage Star Ratings
Friday, October 16th, 2020

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released its 2021 Medicare Advantage and Part D star ratings. Just over twenty health plans earned five stars, including familiar names like Cigna and CarePlus by Humana. Only four health plans had low ratings of 2.5 stars, and there were no plans with ratings below that.

The CMA star rating system began for Medicare Advantage plans in 2008 to monitor performance on selected criteria for beneficiaries. By 2012, those metrics were tied to payments and bonuses for quality incentives. On a scale of one to five stars, CMS rates Medicare Advantage health and drug plans, with one star indicating bad results and five stars meaning outstanding performance.

The new star ratings are good news for the more than one-third Medicare beneficiaries who choose a Medicare Advantage plan. Medicare Advantage premiums in 2021 will be the lowest since 2007. The average star rating has increased from 4.02 in 2017 to 4.06 in 2021, and, according to CMS, approximately 77% of beneficiaries enrolling in Medicare Advantage plans with drug coverage will participate in plans with four or more stars.

Up to 44 separate consistency and success metrics are classified for Medicare Advantage with Medicare Part D prescription drug coverage contracts, and up to 32 metrics are classified for Medicare Advantage-only contracts (without coverage for prescription drugs). No new measures have been introduced for 2021. However, CMS is taking into account patient comments and experiences more heavily, including the quality of care being received by the plans. The effect of the coronavirus on star ratings has been tracked by CMS and several improvements have been implemented to forestall the impact.

To read more, please visit https://www.healthcarefinancenews.com/news/21-medicare-advantage-plans-earn-5-stars-cms-release-star-ratings.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

CMS Shares COVID-19 Data Reporting Guidance
Friday, October 9th, 2020

CMS recently shared guidance on how it aims to enforce a recent temporary final rule mandating condition of participation (CoP) in Medicare for hospitals publishing COVID-19 results.

The guidelines issued earlier this week declared that, during the pandemic, hospitals risk Medicare termination should they fail to report daily on the more than 30 measures required by CMS. The metrics comprise regular COVID-19 admissions, including those affecting ventilated patients, fatalities from COVID-19, and other virus-related hospital utilization data.

Hospitals will now have to submit weekly supply-related metrics and also report new cases of influenza. This is presently voluntary but will become obligatory in November.

Beginning October 7, 2020, hospitals that do not meet the COVID-19 data reporting standards will be given a CMS warning. The hospitals will have three weeks to address any discrepancies in implementation, according to guidelines. Following these warnings, a second advisory alert will be given by CMS to hospitals failing to send out the required daily information.

In general, before being terminated from federal healthcare services, hospitals have a total of 14 weeks to meet Medicare CoP. These terminations would mean hospitals would not obtain payment for the treatment of recipients of Medicare and Medicaid.

To read more, please visit https://revcycleintelligence.com/news/cms-releases-guidance-on-covid-19-data-reporting-as-medicare-cop.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

South Florida Healthcare Practice Rises Early to the COVID-19 Challenge
Thursday, October 8th, 2020

As the coronavirus made its way to South Florida, CareMax Medical Centers was already adjusting its healthcare delivery model to face the challenges practices would soon need to address. CareMax partnered with CareOptimize early on to help proactively address COVID-19 challenges with productive responses. Within three days, the team implemented several policies and procedures to ensure staff and members stayed safe. Many of these have now been made permanent.

CareMax began offering its members virtual appointments before telehealth gained widespread use, enabling CareMax physicians to remain completely available to members. For those members who do not have a computer or may be technologically challenged, CareMax Transportation drivers take tablets to members’ homes, so they can participate in a virtual visit.

Using the CareOptimize service-as-software platform “HeartBeat,” providers have information on all members to facilitate clinical decisions as well as continue to track members with chronic issues, alleviating problems inherent with prolonged breaks in care.  All patients identified as positive or suspected COVID-19 cases are kept on a frequently updated list. Physicians give daily virtual video visits to every single one of these patients to monitor their progress. Anyone admitted to a hospital receives a virtual visit immediately afterward and, if appropriate, an in-home visit from a CareMax home health nurse.

To ensure constant communication, every member receives a weekly wellness check phone call to ensure they are well, continuing safe habits, and maintaining a proper diet. Should there be an issue, members can request a virtual visit with a provider or a visit from a home health nurse.

To keep costs down and better assist those that need attention, the “Call CareMax First” campaign was developed to encourage members to contact CareMax before heading to a hospital. This simple procedure has helped prevent unnecessary hospital visits, while allowing members to connect with a medical professional at all hours of the day, every day of the week.

COVID19 has forced the healthcare industry to rethink the way things are done. Thinking outside the box is something CareOptimize has always done for each and every one of their clients. The challenges continue, so do the solutions.

To read more about CareMax Medical Centers, please visit https://www.prnewswire.com/news-releases/healthcare-with-heart-is-more-than-a-slogan-at-caremax-301143889.html.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR

Insights2020 Telehealth and Medicare Advantage
Tuesday, October 6th, 2020

Advance Medicare Payment Relief Is on the Way
Friday, October 2nd, 2020

Near the onset of the pandemic, many clinicians received advanced Medicare payments through CMS’ Medicare Accelerated and Advance Payment Program. The repayment of those funds was recently extended from 210 days to an entire year as part of a resolution recently signed by President Trump, which includes several healthcare-specific provisions.

The Accelerated and Advance Payment Program was instituted when the sharp decline in admissions and visits hospitals and other services were experiencing due to COVID19 became problematic.

Through the program, CMS advances expected Medicare reimbursement and eventually recoups it. Recoupment usually begins 120 days after receipt of the initial payment. That term was extended to 210 days for the pandemic. The recently signed legislation will grant providers a year until CMS will begin reclaiming the disbursements.

For the first eleven months of recovery, CMS is only allowed to offset a provider’s cost by 25 percent. That rises to 50 percent for the following six months. CMS will postpone Medicare reimbursement for 29 months from the date of the first payment under the initiative.

The bill is a victory for caregivers who, given the current public health emergency, have been pressing on lawmakers to grant them more attractive reimbursement terms.

To read more, please visit https://revcycleintelligence.com/news/lawmakers-provide-accelerated-advance-medicare-payment-relief.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

EHR Plays a Role in Value-Based Hospice Care
Thursday, October 1st, 2020

As healthcare transitions towards value-based care, electronic health record (EHR) systems are gradually adding functionality to specifically target providers of end of life and acutely ill care. In order to remain competitive in a packed marketplace and provide data-powered reporting for regulatory obligations, numerous hospice and palliative care providers have stepped up efforts to incorporate electronic systems.

With capabilities to handle treatment plans, prescriptions, and workflows off-site, EHR systems can supply scheduling capabilities for patient intake and continuing visits and evaluations amid hospice clinical and operational teams. To minimize industry-wide worker mental collapse and employee shortfalls, workflow enhancement has been crucial. Electronic analysis of the hospice-specific billing code is an extra function of certain electronic health record-keeping systems to improve productivity and decrease time used on long documentation procedures.

Taking advantage of EHR capabilities may also allow proactive detection of patients who might benefit from severe illness and end of life treatment, facilitating standardized usage of evidence-based screening and evaluation methods. Care coordinators can make use of clinical data to better the quality of reporting, determine the effectiveness of treatment, and enable process and outcome measures to easily extract data.

For more information on our Nextgen EHR products, please visit https://careoptimize.com/products/. This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.