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AMDA Opposed to Cuts to SNF Visits in Proposed CY2021 Physician Fee Schedule – Will be Catastrophic to PALTC Practices and Cause Severe Shortage in Access to Care for America’s Seniors

Policy Snapshot
Skilled Nursing Care, Practice Management, Practitioners
August 13, 2020

One of the unpleasant surprises in the release of the CY2021 Physician Fee Scheduled Proposed Rule earlier this month was an included 8-10% cut to the SNF family of CPT codes. The cuts occurred due to a decrease in the conversion factor that is part of the formula that determines reimbursement for the codes. The redistribution of pay under the physician fee schedule is a result of the budget neutrality requirements linked to the 2020 rule’s increase in pay for evaluation and management (E&M)...

Physician Compare Preview Period Open Through August 20

Policy Snapshot
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Coding, Reimbursement, & Documentation, Practitioners
August 13, 2020

The Physician Compare preview period is open through August 20 at 8:00 PM  ET. Preview your 2018 Quality Payment Program performance information before it appears on the Physician Compare website profile pages and in the downloadable database. Access the secured preview through the Quality Payment Program website.

For more information:

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Aging Organizations Encourage Congress to Establish Nursing Home “Strike Teams” and Provide Funding for Testing, Hazard Pay

Policy Snapshot
Practice Management, Practitioners
August 13, 2020

The Leadership Council on Aging Organizations (LCAO)—a coalition of 69 national, non-profit organizations (including AMDA) concerned with the well-being of America’s older population—sent a letter to congressional leadership urging them to take swift action to pass COVID-19 relief legislation that protects the well-being of older Americans.

In relation to nursing homes and assisted living facilities, the letter urged Congress to include strike teams to help with residents diagnosed with COVID-19. The strike teams would be there to bolster workplace safety, infection control, staff...

CMS Issues Proposed Physician Fee Schedule and Quality Payment Proposed Rules; Changes to Telehealth Services Included

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Coding, Reimbursement, & Documentation, Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practice Management, Practitioners, Telemedicine
August 6, 2020

The Centers for Medicare & Medicaid Services (CMS) released its Proposed Rule Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 202.

Included in the fee schedule were a number of telehealth provisions that either extended current waivers under the public health emergency or added new services. Of note, CMS is proposing to revise its long-standing policy on frequency of subsequent nursing facility visits via telehealth. They say:

“In response to...

Nursing Home Compare Refresh

Policy Snapshot
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Practice Management, Practitioners
August 6, 2020

The July 2020 Nursing Home Compare refresh is available, including quality measure results based on Skilled Nursing Facility (SNF) Quality Reporting Program data. Visit the Nursing Home Compare website to view the data.

For more information:

CMS Finalizes SNF Prospective Payment System (PPS) for 2021

Policy Snapshot
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Payment
August 6, 2020

The Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1737-F] for Fiscal Year (FY) 2021 that updates the Medicare payment rates and the value-based purchasing program for skilled nursing facilities (SNFs). The rule included an increase net market basket of 2.2%. CMS estimates it would increase Medicare SMF payment by almost $750 million in FY 2021.

CMS is finalizing changes to the ICD-10 code mappings, effective October 1, 2020. CMS encourages stakeholders to continue to provide this essential feedback on the ICD-10 code mappings so that they may continue...

Senate Leadership Introduces New COVID Relief Package; Includes Nursing Home Support

Policy Snapshot
COVID-19, Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Practitioners, Telemedicine
July 30, 2020

Last week, Senate Finance Committee Chair Chuck Grassley (R-IA) introduced a new COVID-19 relief package, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).

The bill includes proposals to have the Department of Health and Human Services (HHS) create nursing home strike teams, develop online staff training courses on infection control, and provide governors a list of all Medicare and Medicaid-enrolled nursing facilities that saw an increase in the number of COVID-19 cases in the previous week.

The nursing home strike teams would help perform medical...

COVID-19: Laboratory Claims Requiring the NPI of the Ordering/Referring Professional — Update

Policy Snapshot
COVID-19, Coding, Reimbursement, & Documentation, Practitioners
July 30, 2020

During the COVID-19 Public Health Emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) relaxed requirements for a limited number of laboratory tests required for a COVID-19 diagnosis. These tests do not require a practitioner order during the PHE. CMS added a new test to this list: CPT 87426 (infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or...

Provider Relief Fund Update

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Practitioners
July 23, 2020

The U.S. Department of Health and Human Services (HHS) extended the deadline for eligible Medicaid and CHIP physicians and organizations to submit...

New Resources to Protect Nursing Home Residents Against COVID-19 Announced by CMS

Policy Snapshot
COVID-19, Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Practice Management, Practitioners
July 23, 2020

Last week, the Centers for Medicare & Medicaid Services (CMS) announced initiatives designed to protect nursing home residents from coronavirus disease 2019 (COVID-19).

New Funding

The U.S. Department of Health and Human Services (HHS) will devote $5 billion of the Provider Relief Fund authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act to Medicare-certified long-term care facilities and state veterans’ homes (nursing homes), to build nursing home skills and enhance nursing homes’ response to COVID-19, including enhanced...