6/25 | CMS Open Door Forum | Documentation Requirement Lookup Service

From the Centers for Medicare and Medicaid Services Special Open Door Forum:  Medicare Documentation Requirement Lookup Service Thursday, June 25, 2020 | 2:00-3:00 pm Eastern Time Conference Call Only The Centers for Medicare & Medicaid Services, Center for Program Integrity will host a series of Special Open Door Forum (SODF) calls to educate the public about a new initiative underway to develop a Medicare Fee for Service (FFS) Documentation Requirement Lookup Service prototype. Also, to allow physicians, suppliers, IT and Electronic Health Record (EHR) Developers and Vendors, and/or all other interested parties to provide feedback to CMS and inform how interested parties can get involved or track the progress of this initiative. CMS is collaborating with ongoing industry efforts to streamline workflow access to coverage requirements, starting with developing a prototype Medicare FFS Documentation Requirement Lookup Service and is participating in two workgroups to promote development of standards that will support the Lookup Service. One workgroup is a private sector initiative hosted by Health Level Seven (HL7), the Da Vinci project. The second workgroup is The Office of the National Coordinator for Health Information Technology (ONC) Fast Healthcare Interoperability Resource (FHIR) at Scale Taskforce (FAST). By working with HL7, ONC, (more…)

AAA Sends letter on Accelerated Payments

On May 26, the AAA sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma, requesting improvements to the Medicare Accelerated and Advance Payment (MAAP) Programs. The nation’s response to the COVID-19 pandemic is putting an increased financial strain on emergency medical services, and ground ambulance service providers and suppliers already faced significant funding challenges. The suggested improvements include: Extending the interim period prior to the date repayment begins from four months to at least 12 months; Reducing the amount that is withheld during the repayment period from one hundred percent (100%) of the Medicare payment to not more than twenty-five percent (25%); Extending the date on which interest first begins to accrue from 210 days to at least 2 years (preferably 3 years); Reduce the interest rate that would be applicable after that date from the current 9.625 percent to a rate of no more than 2%; and Reopen the MAAP to allow EMS agencies that did not request a Medicare advance prior to April 26, 2020 to request an advance. The AAA believes the improvements to the MAAP discussed above would provide short-term financial relief to ambulance service providers and suppliers nationwide and allow us...

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HHS Announces Plans for Distribution of Remaining CARES Act Provider Relief Funding

HHS Announces Plans for Distribution of Remaining CARES Act Provider Relief Funding By Brian S. Werfel, Esq. March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).  As part of that Act, Congress allocated $100 billion to the creation of a “CARES Act Provider Relief Fund,” which will be used to support hospitals and other healthcare providers on the front lines of the nation’s coronavirus response.  These funds will be used to fund healthcare-related expenses or to offset lost revenue attributable to COVID-10.  These funds will also be used to ensure that uninsured Americans have access to testing a treatment for COVID-19.  Collectively, this funding is referred to as the “CARES Act Provider Relief Fund.” The Department of Health and Human Services (HHS) began the disbursement of the first $30 billion tranche of the CARES Act Provider Relief Funding on April 10, 2020, with full disbursement of this tranche being completed by April 17, 2020.  The American Ambulance Association has issued a Frequently Asked Question that provides additional details on how the payments under this first tranche were calculated, as well as the terms and conditions that are applicable to this disbursement. On...

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FAQs – HHS CARES Act Provider Relief Funding

Frequently Asked Questions (FAQs) related to HHS CARES Act Provider Relief Funding By Brian S. Werfel, Esq. In March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).  As part of that Act, Congress allocated $100 billion to the creation of a “CARES Act Provider Relief Fund,” which will be used to support hospitals and other healthcare providers on the front lines of the nation’s coronavirus response.  These funds will be used to fund healthcare-related expenses or to offset lost revenue attributable to COVID-10.  These funds will also be used to ensure that uninsured Americans have access to testing a treatment for COVID-19.  Collectively, this funding is referred to as the “CARES Act Provider Relief Fund.” On April 9, 2020, the Department of Health and Human Services (HHS) began the disbursement of the first $30 billion of this provider relief funding.  This disbursement was made to all healthcare providers and suppliers that were enrolled in the Medicare Program, and who received Medicare Fee-for-Service reimbursements during Calendar Year 2019.  For most ambulance providers and suppliers, these relief funds were automatically deposited into their bank accounts. In this Frequently Asked Question (FAQ), the AAA...

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CMS Office Hours on COVID-19

CMS Office Hours on COVID-19 You are invited to CMS “Office Hours” on COVID-19, today, Thursday, April 16th from 5:00 – 6:00 PM Eastern, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to: Increase Hospital Capacity – CMS Hospitals Without Walls; Rapidly Expand the Healthcare Workforce; Put Patients Over Paperwork; and Further Promote Telehealth in Medicare Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership. Toll-Free Attendee Dial In: 833-614-0820 Event Plus Passcode: 6168487 Audio Webcast link You can find a copy of the full press release and related materials HERE To keep up with the important work the White House Task Force is doing in response to COVID-19, please click here: www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website....

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CMS: Medical Necessity & Patient Signature Requirements During COVID-19

CMS Clarifies Medicare Requirements Related to Medical Necessity and the Patient Signature Requirement during Current National State of Emergency By Brian S. Werfel, Esq. On April 9, 2020, CMS updated its Frequently Asked Questions (FAQs) for billing Medicare Fee-For-Service Claims during the current national state of emergency.  This document includes guidance for numerous industry types, including ambulance services.  The ambulance-specific questions start on page 11. Two of the more common questions that A.A.A. members have asked during the current crisis are: Whether the transportation of a patient known or suspected to be infected with the COVID-19 virus would automatically justify medical necessity for the ambulance? And, Whether CMS will be waiving the requirement that ambulance providers and suppliers obtain the patient’s signature (or an acceptable alternative signature) to consent to the submission of a claim? CMS did provide some guidance on both of these issues. CMS addressed the issue of medical necessity in its answer to Question #9 on page 13.  The question posed to CMS was whether an ambulance provider/supplier could consider any COVID-19 positive patient to meet the medical necessity requirements for an ambulance.  CMS responded as follows: “Answer: The medical necessity requirements for coverage of ambulance services...

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2020 Medicare Reference Manual & Medicare Update Webinar

The 2020 Medicare Reference Manual and the 2020 Medicare Update Webinar are both available for purchase. Please see details below! 2020 Medicare Update Webinar Thursday, April 30, 2020 | 2:00pm EST Presenter: Brian Werfel, Esq. $99 for AAA-Members | $198 for Non-Members Join A.A.A. Medicare Consultant Brian S. Werfel, Esq. for an update on recent changes to Medicare’s coverage of ambulance services. This webinar coincides with the American Ambulance Association’s release of its 2020 Medicare Reference Manual. Brian will discuss recent changes in Medicare policy, including changes to the rules governing the enforcement of fraud and abuse, the appeals process, etc. We will also discuss Medicare’s proposed plan for the ET3 Program, the national expansion of the prior authorization model for scheduled non-emergency transports, and much more. Of course, we will also discuss Medicare’s coverage of ambulance services during the current COVID-19 process. This will include a frank discussion of the issues related to medical necessity for the transportation of known or suspected COVID-19 patients, the coverage of transports to field hospitals and other alternative destinations, the current status of certain administrative rules like the Medicare patient signature requirement and the Notice of Privacy Practices, etc. The session will include an extended (more…)

CMMI Delays ET3 Pilot Program Until Fall

The Centers for Medicare and Medicaid Innovation (CMMI) has announced the delay of the start of the ET3 Model Pilot Program. CMMI has delayed the program until the fall of this year. The program was set to begin on May 1. In its notice, CMMI also referenced the interim final rule providing waivers for transport to alternative destinations and other regulatory flexibility previously reported by the AAA. ET3 Model Timeline Delay and Important Updates ET3 Model Stakeholders, Thank you for your engagement to date related to the ET3 Model. The Centers for Medicare & Medicaid Services (CMS) is seeking to support the community of organizations that are responding to the public health emergency stemming from the Novel Coronavirus Disease (COVID-19). As CMS and ET3 Model selected applicants work to respond to needs due to COVID-19, CMS has decided to delay the start of the ET3 Model from May 1, 2020 until Fall 2020. CMS appreciates your continued support and enthusiasm for the innovations available under the ET3 Model, and as such, we will continue to communicate information and updates about the Model through this listserv. Important Updates Regarding CMS Flexibilities to Fight COVID-19 In addition, we want to inform ET3...

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New CMS Infection Control Guidance for COVID-19

FOR IMMEDIATE RELEASE April 8, 2020 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries  CMS Issues New Wave of Infection Control Guidance Based on CDC Guidelines to Protect Patients and Healthcare Workers from COVID-19 Guidance will aid clinicians in various healthcare settings to prevent and mitigate the spread  Under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) has issued a series of updated guidance documents focused on infection control to prevent the spread of the 2019 Novel Coronavirus (COVID-19) in a variety of inpatient and outpatient care settings. The guidance, based on Centers for Disease Control and Prevention (CDC) guidelines, will help ensure infection control in the context of patient triage, screening and treatment, the use of alternate testing and treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning and disinfection guidelines, staffing, and more. The guidance is designed to empower local hospitals and healthcare systems, helping them to rapidly expand their capacity to isolate and treat patients infected with COVID-19 from those who are not. Critically, the guidance released today includes new instructions for dialysis facilities as they work to protect patients with End-Stage Renal Disease (ESRD), who, because of their immunocompromised state (more…)

4/8: CMS Telehealth Open Door Forum

CMS invites you to a Special Open Door Forum addressing CMS’ actions to increase access to Telehealth in Medicare during the COVID-19 Public Health Emergency. This Special Open Door Forum is open to everyone, if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you. This call will begin promptly at 1:30 PM on Wednesday, April 8. Wednesday, April 8 1:30-2:30 PM ET Dial-in Information 1-888-455-1397 Participant passcode: 3535324 Please dial in 15 minutes ahead of time Additional Information CMS has also released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. Video You can access recordings of this call along with transcripts on the following link: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts. We will continue to host calls and share information through our list serves and media.

AAA Sends Letter to HHS on COVID-19 Response

On April 6, the AAA sent a letter to Health and Human Services Secretary Azar requesting that the Department distribute direct payments to all ambulance service providers and suppliers who are on the front lines of the COVID-19 pandemic. The AAA requested funding under the $100 Billion Public Health and Social Service Emergency Fund, established by the CARES Act, in the amount of $48,000 per ambulance registered as of April 1. The AAA estimates the payments would represent approximately $2.6 billion in desperately-needed relief for our industry. Read the letter HERE....

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