Posted April 2022

Reimbursement

• COVID-19 PHE is Renewed Through July 15
• CMS continues to gradually end some emergency blanket waivers allowed under the COVID-19 public health emergency (PHE) for some providers, but for now the 1135 waivers remain intact for acute care and critical access hospitals. The current 90-day PHE declaration was renewed and posted online Wednesday, and is effective through July 15.
• Telehealth Place of Service Code: Effective for date of service on or after January 1, 2022, the Center for Medicare and Medicaid Services (CMS) allowed the new telehealth place of service (POS) code 10 - telehealth provided in patient's home. The telehealth POS change was implemented on April 4, 2022. Read the complete update

Outpatient

• Did you know that Targeted Probe and Educate (TPE) is resuming? Visit the Noridian Medicare Website for more information and upcoming webinars. Additional information can be found on the CMS website at Targeted Probe and Educate | CMS
• DMEPOS Items: Medical Record Documentation. For Medicare to cover any Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item, the patient's medical record must include enough documentation to justify the need for the a) type and quantity of items ordered and b) frequency of use (or replacement if applicable). Read the complete update
• Prior Authorization (PA) for Certain Hospital Outpatient Department (OPD) Services Webinar - May 10, 2022
• New WOPD and Face-to-Face Required List HCPCS Code Look Up Tool - Now Available: Did You Know we have a New WOPD and Face-to-Face Required List HCPCS Code Lookup Tool? This tool will assist suppliers and billers determine which HCPCS codes require a written order prior to delivery (WOPD) and face-to-face (F2F) encounter. Effective April 13, 2022, HCPCS codes listed in the Federal Register will require a WOPD and F2F within six months preceding the date of the WOPD. The tool can be found on the Noridian website.

Inpatient

• CMS pitches inpatient payment rule for 2023: 10 things to know.  See CMS updates

Post acute

• On April 11, CMS issued its fiscal year (FY) 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS) proposed rule, which includes asking for public feedback on how staffing in nursing homes and health equity improvements could lead to better health outcomes.
• In January, CMS began posting nursing home staff turnover rates (as well as weekend staff levels) on the Medicare.gov Care Compare website, and CMS will be including this information in the star rating system starting in July 2022.

Quality

Outpatient

• The new #MIPS Value Pathways (MVPs) reporting framework will begin in performance year 2023 with 7 MVPs. Want to learn how choosing this participation option will benefit you and your patients? Watch CMS' new video for an overview
  
• 2022 CAHPS for MIPS Overview Fact Sheet (PDF)
  
• Quality Performance Category: Traditional MIPS Requirements - Performance Year 2022
  
• Groups, virtual groups, and Alternative Payment Model (APM) Entities with 25 or more clinicians (including at least one MIPS eligible clinician) can register through June 30, 2022, to use the CMS Web Interface for reporting quality measures under traditional MIPS. See 
• CAHPS for MIPS Survey
• If your group, virtual group, or APM Entity participating in traditional MIPS registers for and meets the sampling requirements for the CAHPS for MIPS Survey, this may count as 1 of the 6 required measures or can be reported in addition to the 10 measures required for the CMS Web Interface.

Inpatient

• Advancing Health Equity: CMS Proposes Policies to Advance Health Equity & Maternal Health, Support Hospitals
• Health equity means the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes. To address health care disparities in hospital inpatient care and beyond, CMS is proposing three health equity-focused measures for adoption in the Hospital Inpatient Quality Reporting (IQR) Program. The first measure assesses a hospital’s commitment to establishing a culture of equity and delivering more equitable health care by capturing concrete activities across five key domains, including strategic planning, data collection, data analysis, quality improvement, and leadership engagement. The second and third measures capture screening and identification of patient-level, health-related social needs—such as food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. By screening for and identifying such unmet needs, hospitals will be in a better position to serve patients holistically by addressing and monitoring what are often key contributors to poor physical and mental health outcomes.

Posted March 2022

Reimbursement

• Inpatient Rehabilitation Facilities: Fiscal Year 2023 Proposed Rule - Submit Comments by May 31. On March 31, CMS issued the fiscal year 2023 inpatient rehabilitation facility (IRF) prospective payment system proposed rule to update Medicare payment policies and rates. See a summary of key provisions.Proposals include:
• Updating payment rates by 2.8%, with estimated overall payments to increase by 2.0% after productivity and outlier adjustments
• Applying a permanent 5% cap on annual wage index decreases
• Expanding quality data reporting on all IRF patients, regardless of payer
• Noridian: Manipulated, Reconstituted and/or Injectable Amniotic and Placental Derived Products
• The public notice issued on 2/23/22 has been rescinded as of 3/25/22. Further direction on previously processed and newly submitted claims will be forthcoming. Please continue to watch our website and Listserv email for further direction. Read the complete update

Posted November 2021

Reimbursement

• Noridian's Final Wound and Ulcer Care LCD (L38902) and Associated Billing and Coding: Wound and Ulcer Care Article (A58565) - Effective November 28, 2021
• HCPCS Application Summaries & Coding Decisions: 510(k)-Cleared Wound Care Products
  
• Modifier 59, National Correct Coding Initiative (NCCI) and Medically Unlikely Edit (MUE) Webinar - November 30, 2021 This event includes: National Correct Coding Initiatives (NCCI), Procedure to Procedure (PTP) CCI Edits, Modifier 59, Medically Unlikely Edits (MUEs), Correct Coding Initiative (CCI) Examples, Resources
• Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
• See topic "Coding and Billing Essentials in Wound Care"
• Targeted Probe and Educate (TPE) A/B Webinar - December 15, 2021 This event includes: TPE Process, Initiating Reviews, Provider Notification, Completing and Closing File, and Resources
• CMS Physician Payment Rule Promotes Greater Access to Telehealth Services, Diabetes Prevention Programs. On November 2, CMS is announcing actions that will advance its strategic commitment to drive innovation to support health equity and high quality, person-centered care. CMS’ Calendar Year (CY) 2022 Physician Fee Schedule (PFS) final rule will promote greater use of telehealth and other telecommunications technologies for providing behavioral health care services, encourage growth in the diabetes prevention program, and boost payment rates for vaccine administration. The final rule also advances programs to improve the quality of care for people with Medicare by incentivizing clinicians to deliver improved outcomes.
  
• To further improve the quality of care for people with Medicare, the PFS final rule makes several key changes to CMS’ Quality Payment Program (QPP), a value-based payment program that promotes the delivery of high-value care by clinicians through a combination of financial incentives and disincentives. For example, CMS finalized a higher performance threshold that clinicians will be required to exceed in 2022 to be eligible for positive payment incentives. This new threshold was determined in accordance with statutory requirements for the QPP’s Merit-based Incentive Payment System (MIPS).
• CMS is also moving forward with the next evolution of QPP and officially introducing the first seven MIPS Value Pathways (MVPs)  ̶  subsets of connected and complementary measures and activities, established through rulemaking, that clinicians can report on to meet MIPS requirements. MVPs are designed to ensure more meaningful participation for clinicians and improved outcomes for patients by more effectively measuring and comparing performance within different clinician specialties and providing clinicians more meaningful feedback. This initial set of MVP clinical areas include: rheumatology, stroke care and prevention, heart disease, chronic disease management, lower extremity joint repair (e.g., knee replacement), emergency medicine, and anesthesia.
• CMS is implementing a recent statutory change that authorizes Medicare to make direct Medicare payments to Physician Assistants (PAs) for professional services they furnish under Part B. For the first time, beginning January 1, 2022, PAs will be able to bill Medicare directly.
• Payments to primary care specialists that involve more clinical labor, such as family practice, geriatrics, and internal medicine specialties, are expected to increase. This increase will to drive greater person-centered care for these services particularly for disadvantaged groups and underserved communities. There will be a four-year transition period to implement the clinical labor pricing update, which will help maintain payment stability and mitigate any potential negative effects on health care providers by gradually phasing in the changes over time.
• Final Policies for the Medicare Diabetes Prevention Program (MDPP) Expanded Model for the Calendar Year 2022 Medicare Physician Fee Schedule
• CMS OPPS/ASC Final Rule Increases Price Transparency, Patient Safety and Access to Quality Care
• Price Transparency of Hospital Standard Charges: Beginning January 1, 2022, CMS will increase the penalty for some hospitals that do not comply with the Hospital Price Transparency final rule. Specifically, CMS is setting a minimum civil monetary penalty of $300 per day that will apply to smaller hospitals with a bed count of 30 or fewer, and a penalty of $10 per bed per day for hospitals with a bed count greater than 30, not to exceed a maximum daily dollar amount of $5,500. Under this approach, for a full calendar year of noncompliance, the minimum total penalty amount would be $109,500 per hospital, and the maximum total penalty amount would be $2,007,500 per hospital.
• Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs: CMS is also enhancing beneficiary protections by finalizing policies that will allow for a more evidence-based approach in determining whether procedures should be payable in the outpatient setting. In the CY 2021 OPPS/ASC final rule, CMS finalized a policy to eliminate the Inpatient Only (IPO) list over a three-year period, removing 298 services in the first phase of the elimination. A large number of stakeholder comments opposed elimination of the list, primarily due to safety concerns with performing certain procedures in an outpatient setting. For CY 2022, CMS is halting the elimination of the IPO list and, after clinical review of the services removed from the list in CY 2021, CMS is adding all but a small number of procedures back to the list. CMS is also reinstating the ASC Covered Procedures List (CPL) criteria that were in effect in CY 2020 and adopting a process for stakeholders to nominate procedures they believe meet the requirements to be added to the ASC CPL
• Final Policies for the Medicare Diabetes Prevention Program (MDPP) Expanded Model for the Calendar Year 2022 Medicare Physician Fee Schedule
• Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Changes
• Home Health Value-Based Purchasing (HHVBP) Model Expanded Nationwide : Throughout 2022, CMS will provide technical assistance to HHAs to ensure they understand how performance will be assessed. The first performance year will begin January 1, 2023. Adjustments will be made to HHA Medicare fee-for-service payments in 2025, according to their performance in 2023. 
• CMS Finalizes Calendar Year 2022 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model Expansion. 

Quality

• Resources Available: For individuals working with a Qualified Clinical Data Registry (QCDR) who are planning on submitting quality measures, promoting interoperability measures, and/or improvement activities for the 2021 Merit-based Incentive Payment System (MIPS) performance year, a list of all approved QCDRs can be found here 
• The Medicare Promoting Interoperability Program requires participants to report on four self-selected electronic clinical quality measures (eCQMs) from the set of nine available. The data submission deadline is February 28, 2022. Click here to learn more. 
• CMS Publishes 2022 PFS Final Rule for the Quality Payment Program. 
• Register for the November 10 Overview of the 2022 Quality Payment Program Final Rule Webinar
• 2022: QPP Final Rule Highlights. Key QPP policies in the 2022 performance year include:
• Revising the definition of a MIPS eligible clinician to include social workers and certified nurse mid-wives.
• Setting the MIPS performance threshold at 75 points and the exceptional performance threshold at 89 points.
• Weighting the cost and quality performance categories equally (as statutorily required) at 30%.
• Extending the CMS Web Interface as a collection type and submission type in traditional MIPS for registered groups, virtual groups, and APM Entities for the 2022 performance year only.
• Finalizing a longer transition for electronic clinical quality measures (eCQMs)/MIPS clinical quality measures (CQMs) measure reporting for Shared Savings Program Accountable Care Organizations (ACOs) by extending the CMS Web Interface as an option for 3 years (through the 2024 performance year).
• 2023 and Beyond: QPP Final Rule Highlights – Additional Finalized Policies. The following updates were also included in the PFS Final Rule and affect future years of the QPP:
• Finalizing 7 MVPs that will be available, beginning with the 2023 performance year.
• Providing a description of the registration process and timeline for MVP and subgroup registration, beginning with the 2023 performance year.

Posted October 2021

Reimbursement

• NEW Noridian Local Coverage Determinations and Articles Effective Dates 11/28/21
• A58567 - Billing and Coding: Wound and Ulcer Care
• A58565 - Billing and Coding: Wound and Ulcer Care
• A58904 - Response to Comments: Wound and Ulcer Care 
• A58903 - Response to Comments: Wound and Ulcer Care
• L38904 - Wound and Ulcer Care
• L38902 -Wound and Ulcer Care
• The Choose Home Care Act, legislation that aims to give Americans a choice on where to recover after a hospital discharge, was introduced into the House of Representatives on October 8.
• The bipartisan legislation is designed to increase access to home health care following hospitalization for eligible Medicare beneficiaries by offering a safe, high-quality post-acute option for nursing home level services in the home. 
• Noridian Wheelchair Seating LCD update  Revision Effective Date: 10/01/2021
• ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
• Revised: ICD-10-CM code G71.20 description in Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates
• Added: ICD-10-CM code G04.82 to Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates

Posted September 2021

Clinical

• Efficacy and safety of hyperbaric oxygen treatment in SARS-COV-2 (COVID-19) pneumonia: a systematic review. Limited and weak evidence from non-randomized studies including one propensity-matched cohort study suggests HBOT is safe and may be a promising intervention to optimize treatment and outcomes in hypoxemic COVID-19 patients.
• Efficacy of topical cadexomer iodine treatment (CIOD) in chronic wounds: Systematic review and meta-analysis of comparative clinical trials. Meta-analyses highlighted the positive impact of CIOD on mean wound area reduction (MD = 2.35 cm2 , 95% CI = 0.34-4.36, P = .0219) after eight weeks treatment and overall wound healing events compared to standard of care (SOC); wounds including venous leg ulcers, diabetic foot ulcers, and pressure ulcers treated with CIOD were more than twice as likely to heal than those receiving SOC (RR = 2.30, 95% CI = 1.54-3.45, P < .0001). This meta-analysis demonstrates the efficacy of CIOD on chronic wounds through removal of barriers to healing.
• The measurement properties of assessment tools for chronic wounds: A systematic review
• The Effectiveness and Safety of Platelet-Rich Plasma for Chronic Wounds: A Systematic Review and Meta-analysis. Autologous PRP may increase complete wound closure, shorten healing time, and reduce wound size in individuals with lower-extremity diabetic ulcers. The evidence is insufficient to estimate an effect on wound healing in individuals with lower-extremity venous ulcers or pressure ulcers.
  
• AHRQ Interventions To Decrease Hospital Length of Stay 

Telehealth/ telemedicine

• Hospitals Plan For Telehealth Expansion Despite Declining Use and Clinicians Show Intent to Continue Telehealth Use Post-Pandemic. 
• In a survey with 100 responses performed by KLAS Research and the Center for Connected Medicine, more than 80 percent of hospitals and health systems reported that telehealth visits comprised 20 percent or less of their total appointments during the two-month span. However, hospitals are still interested in expanding telehealth services, to better manage patient populations while keeping costs down. The top three areas for future telehealth expansion cited by survey respondents were chronic care management, behavioral health and urgent care.
• In a study with 207 responses, participants anticipated continuing use of virtual visits with an average of 43.9% post-pandemic. Overall, 74.5% of participants were satisfied with their experience using virtual visits, and 88% believed they could incorporate virtual visits well within the usual workflow. Participants highlighted some challenges in offering virtual care. For example, 58% were concerned about patients’ limited access to technology, 55% about patients’ knowledge of technology, and 41% about the lack of integration with their current EMR, the increase in demand over time, and the connectivity issues such as inconsistent Wi-Fi/Internet connection.
• The Biden administration in August gave $19 million in grants to expand telehealth in rural and underserved communities, with the funding allocated to help train primary care providers, bolster groups providing virtual care, pilot new telehealth services and research the efficacy of digitally delivered care in rural areas. The $19 million will be distributed to 36 awardees through the HHS Health Resources and Services Administration.
  
• Where the US stands on telehealth coverage: 13 states with emergency orders that ended or will end soon and how they are approaching telehealth coverage. Illinois, Maine and Wisconsin have or will transition to permanent telehealth coverage policies.
• Back in July 2021, CMS proposed to expand Telehealth Coverage in Proposed 2022 Physician Fee Schedule. The proposal includes expanding Medicare coverage for telehealth services that address mental health and substance abuse issues and extending most COVID-19 freedoms until the end of 2023, as well as some coverage for FQHCs and RHCs.

Reimbursement

• CGS Administrators, LLC. Local Coverage Article A56696- Billing and Coding: Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities updated. 
• Added new code Q4254 to group 2 HCPCS/CPT codes.
• HCPCS code Q4145 and Q4177 were removed from CPT/HCPCS codes group 2 as they are not FDA approved for the indications outlined in policy L36690.
• Targeted Probe and Educate (TPE) Resumption: The Targeted Probe and Educate (TPE) program is set to resume. Medical Review’s Targeted Probe and Educate (TPE) program was temporarily suspended due to the COVID-19 Public Health Emergency (PHE) to help ease some of the burden on providers, facilities, and suppliers. CMS has authorized the Medicare Administrative Contractors (MACs) to conduct a 20-40 claim preview for A/B providers utilizing the normal TPE process. If the Round One results in an acceptable error rate, no further action is required, and the TPE review will be closed. Several webinars to review the TPE process will be held over the next few months. Read the complete update. Check WoundReference topic "Medicare Targeted Probe and Educate Protocol" (PRO+HBO plan)
• Targeted Probe and Educate (TPE) Resumption Webinar - October 13, 2021
• Did you know there are five levels of appeal? First level - Redeterminations, with Noridian or your MAC. Second level - Reconsiderations, with the Qualified Independent Contractor (QIC). Third level - Administrative Law Judge (ALJ) Hearing, with HHS OMHA Centralized Docketing. Fourth level - Medicare Appeals Council Review, with DAB or ALJ Hearing Office. Fifth level - Federal Court Review, with information on DAB decision.
  
• Noridian Ankle-Foot/Knee-Ankle-Foot Orthosis Webinar - October 19, 2021
• Noridian General Documentation Requirements Webinar - October 28, 2021
• Noridian Prior Authorization Denials on DMEPOS due to Provider Medical Records Webinar - October 27, 2021
  
• Noridian Documentation Checklist for Surgical Dressings  and other documentation checklists:
• Medicare covers primary or secondary surgical dressings:
• Used to protect or treat a wound
  
• If needed after debridement of a wound
  
• The patient’s medical records should include clinical information to demonstrate reasonable and necessary need for the type and quantity of surgical dressings. Providers must evaluate the wound monthly and update the record, unless they document why they can't do a monthly evaluation and how they're monitoring the patient's ongoing use of dressings.
• CMS SNF Consolidated Billing Web-Based Training - Revised
• Coverage and payment guidelines
• Services in a non-covered Part B stay
• Agreements between Skilled Nursing Facilities (SNFs) and other providers
• Excluded Part A SNF consolidated billing services.
• Service Specific Post-Payment Reviews. The Jurisdiction A, DME MAC, Medical Review Department is conducting post-payment service specific reviews on the below specialties. Due to CMS direction, all post-payment reviews will be closing and TPE reviews are resuming. Final Edit Effectiveness results will be posted as they are available.
• Noridian: Enteral Nutrition (L38955) and Parenteral Nutrition (L38953) final LCDs and related Policy Articles - Effective for Claims with Dates of Service on or after September 5, 2021
• CMS Noridian Wheelchair Options and Accessories Webinar - October 7, 2021
• Hospice Quality Reporting Program: Public Reporting Key Dates: The Hospice Quality Reporting Program will resume public reporting in February 2022. To help you prepare, CMS updated the Public Reporting: Key Dates for Providers webpage with information on refreshes through August 2022. For more information, see the Hospice Fiscal Year 2022 Final Rule.

Posted August 2021

Quality

• FDA recommends UHMS-accredited hyperbaric facilities for treatment of specific illnesses
• In a July 26 release entitled “Hyperbaric Oxygen Therapy: Get the Facts” the U.S. Food and Drug Administration (FDA) has cleared the use of hyperbaric oxygen therapy (HBOT/HBO2) for the treatment of several conditions. The release further states: “If your health care provider recommends HBOT, the FDA advises you get the treatment at a hospital or facility that has been inspected and is accredited by the Undersea and Hyperbaric Medical Society.
•  The agency advises that individuals seeking hyperbaric oxygen therapy check with their health care provider to make sure they are pursuing the most appropriate care, noting that some facilities operate outside recognized FDA guidelines. “The FDA is aware there are some hyperbaric oxygen treatment centers promoting hyperbaric oxygen chambers for uses that have not been cleared or approved by the FDA, such as treatment of cancer, Lyme disease, autism, or Alzheimer’s disease.”

Posted July 2021

Reimbursement

• CY 2022 Physician Fee Schedule Proposed Rule with Comment Period: The CY 2022 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on July 13, 2021. This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2022. This proposed rule proposes potentially misvalued codes and other policies affecting the calculation of payment rates. It also proposes to make certain revisions to telehealth services in accordance with the Consolidated Appropriations Act, 2021 (CAA). Additionally, it proposes amendments to telehealth regulatory requirements regarding interactive telecommunications systems and solicits comments on documentation, audio-only, and program integrity guardrails. It also makes several proposals that consider recent changes to Evaluation and Management (E/M) visit codes, such as the current policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physicians involving residents. The proposed rule also proposes modifications to the de minimis standard for therapy services and updates a payment regulation for Medical Nutrition Therapy (MNT) services. Additionally, it includes a comment solicitation on several important considerations regarding vaccine administration services. CMS will accept comments on the proposed rule until September 13, 2021, and will respond to comments in a final rule. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.
• Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds: Effective for claims with dates of service on or after April 13, 2021, Medicare started to accept and pay for autologous PRP for the treatment of chronic non-healing diabetic wounds for a duration of 20 weeks, when prepared by devices whose Food and Drug Administration-cleared indications include the management of exuding cutaneous wounds, such as diabetic ulcers.

Posted March 2021

Clinical

• Telehealth: In response to the increased use and expanded coverage of telehealth during the COVID-19 pandemic, From Coverage to Care (C2C) has released new resources to support patients and providers in making the most of virtual care. Click on the resources below and share this information with your communities.
  
• CMS COVID snapshot: the updated snapshot covers the period from January 1 to December 26, 2020. The updated data show over 2.7 million COVID-19 cases among the Medicare population and nearly 700,000 COVID-19 hospitalizations
• Intratympanic steroid injection versus hyperbaric oxygen therapy in refractory sudden sensorineural hearing loss: a meta-analysis. (Pubmed)
• Chronic wounds: magnitude, socioeconomic burden and consequences (Research Gate)
• Cooling Intervention (MUSTCOOL) for Prevention of Lower Extremity Ulcer Recurrence: A Randomized Controlled Trial.  (Pubmed)
  
• Wound cleansing for treating venous leg ulcers. Cochrane Review
• Developing and Implementing a Dedicated Prone Positioning Team for Mechanically Ventilated ARDS Patients During the COVID-19 Crisis. (Pubmed)
• Systematic Review: Adipose-Derived Mesenchymal Stem Cells, Platelet-Rich Plasma and Biomaterials as New Regenerative Strategies in Chronic Skin Wounds and Soft Tissue Defects
  

Quality

• Doctors and Clinicians Preview Period is ending soon on March 25, 2021 The Doctors and Clinicians Preview Period ends on March 25, 2021 at 8 p.m. ET (5 p.m. PT). If you haven’t previewed your information already, don’t miss your chance to preview your 2019 Quality Payment Program (QPP) performance information before it is publicly reported on clinician and group profile pages on Medicare Care Compare and in the Provider Data Catalog (PDC) . Access the secure preview through the QPP
  
• Register for the 2021 Quality Payment Program Overview Webinar. CMS will answer questions from attendees at the end of the webinar as time permits. Webinar Details Title: 2021 Quality Payment Program Overview Date: Thursday, April 8, 2021 Time: 2:00 – 3:30 p.m. ET
  
• REMINDER: The MIPS 2020 Data Submission Period is Open MIPS Eligible Clinicians Can Submit Data for 2020 through March 31 The data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2020 performance year of the Quality Payment Program (QPP) ends at 8:00 p.m. EDT on March 31, 2021.
  

Posted January 2021

Quality

• Reminder: 2020 MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline for COVID-19 has been Extended to February 1, 2021
  
• The Centers for Medicare & Medicaid Services (CMS) has posted many new Quality Payment Program (QPP) resources to the QPP Resource Library
  
• The Centers for Medicare & Medicaid Services (CMS) is announcing the beta release of the redesigned data.cms.gov website. The goal of the website redesign is to make it easier for users to discover, access, and understand CMS data. CMS is publicly releasing https://data.cms.gov/beta/ 
• Check Your Initial 2021 MIPS Eligibility on the QPP Website; CMS Finalizes New MIPS Reporting Framework
  

Reimbursement

• NEW CMS TRAINING EVENT – Section M: Skin Conditions - Assessment and Coding of Pressure Ulcers/Injuries Web-Based Training. Can be accessed via the Skilled Nursing Facility Quality Reporting Program Training 
• Home Health Value-Based Purchasing (HHVBP) Model Expansion. The U.S. Department of Health and Human Services (HHS) is announcing that HHS Secretary, Alex M. Azar, II, has approved the expansion of the Home Health Value-Based Purchasing (HHVBP) Model.  The HHVBP expansion would be implemented through rulemaking no earlier than January 1, 2022.
  
• On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS): Provided a 3.75% increase in MPFS payments for CY 2021, Suspended the 2% payment adjustment (sequestration) through March 31, 2021, Reinstated the 1.0 floor on the work Geographic Practice Cost Index through CY 2023, Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024, CMS has recalculated the MPFS payment rates and conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is 34.8931. The revised payment rates are available in the Downloads section of the CY 2021 Physician Fee Schedule final rule (CMS-1734-F) 

Posted December 2020

Reimbursement

• On December 1, CMS released the annual Physician Fee Schedule (PFS) final rule, emphasizing permanent expansion of Medicare Telehealth Services and improved payment for time doctors spend with patients. Key takeaways: 
• Payment update. With the budget neutrality adjustment, as required by law, to account for changes in RVUs including significant increases for E/M visit codes, the final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 PFS conversion factor of $36.09.
• Medicare Telehealth and Other Services Involving Communications Technology: more than 60 services were added to the Medicare telehealth list that will continue to be covered beyond the end of the PHE. These additions allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services. Medicare does not have the statutory authority to pay for telehealth to beneficiaries outside of rural areas or, with certain exceptions, allow beneficiaries to receive telehealth in their home. However, this is an important step, and as a result, Medicare beneficiaries in rural areas will have more convenient access to health care. See other updates in the blog post "Reimbursement for Telemedicine Services in Wound Care".
• Direct Supervision by Interactive Telecommunications Technology: For the duration of the COVID-19 PHE, direct supervision may be provided using real-time, interactive audio and video technology through the later of the end of the calendar year in which the PHE ends or December 31, 2021.
• Payment for Office/Outpatient Evaluation and Management (E/M) and Analogous Visits: As finalized in the CY 2020 PFS final rule, in CY 2021 CMS will be largely aligning its E/M visit coding and documentation policies with changes laid out by the CPT Editorial Panel for office/outpatient E/M visits, beginning January 1, 2021. The final rule makes changes to evaluation and management services and codes, including increasing the relative value of several services, such as maternity care bundles and end-stage renal disease capitated payment bundles.
• Policies Regarding Professional Scope of Practice and Related Issues: 
• Supervision of Diagnostic tests by Certain Nonphysician Practitioners (NPPs): CMS is finalizing our proposal to make permanent following the COVID-19 PHE, the same policy that was finalized under the May 1, 2020 COVID-19 IFC (85 FR 27550 through 27629) for the duration of the COVID-19 PHE to allow nurse practitioners (NPs), clinical nurse specialists (CNSs), physician assistants (PAs), and certified nurse-midwives (CNMs) to supervise the performance of diagnostic tests within their scope of practice and state law.  We are adding certified registered nurse anesthetists (CRNAs) to this list.
• Medical Record Documentation: In the CY 2020 PFS final rule, CMS finalized broad modifications to the medical record documentation requirements for physicians and certain NPPs. In this CY 2021 PFS final rule, we are clarifying that physicians and NPPs, including therapists, can review and verify documentation entered into the medical record by members of the medical team for their own services that are paid under the PFS. We are also clarifying that therapy students, and students of other disciplines, working under a physician or practitioner who furnishes and bills directly for their professional services to the Medicare program, may document in the record so long as the documentation is reviewed and verified (signed and dated) by the billing physician, practitioner, or therapist
•  Centers for Medicare & Medicaid Services (CMS) released the final Outpatient Prospective Payment System rule that sets payment rates for hospital services starting on Jan. 1. 
• Under the 2021 OPPS final rule, CMS will pay for 340B-acquired drugs at the average sales prices of the drug minus 22.5 percent versus an older payment methodology in which CMS paid the average sales price plus 6 percent.
• CMS also finalized a 2.4 percent increase in reimbursements to ASCs in 2021.

Clinical

• Real World or Randomized Trial Data? Which is Best to Study Effectiveness in Wound Care? by Caroline Fife, M.D. | Dec 7, 2020.  If you or your company is interested in using real world data, I think that presentation (linked below) is one of the best overviews of the topic. HARNESSING BIG DATA FOR WOUND HEALING RESEARCH: WHICH IS MORE RELEVANT IN THE QUEST FOR EVIDENCE: REAL WORLD PATIENT CENTERED OUTCOMES OR RANDOMIZED TRIALS - Marcia Nusgart R.Ph. Elise Berliner, Ph.D. Caroline E. Fife, M.D. Marissa Carter Ph.D. Presented at ISPOR May 25, 2016

Posted November 2020

Clinical

• CMS Launches Hospital-at-Home Program to Free Up Hospital Capacity. Centers for Medicare & Medicaid Services (CMS) outlined unprecedented comprehensive steps to increase the capacity of the American health care system to provide care to patients outside a traditional hospital setting amid a rising number of coronavirus disease 2019 (COVID-19) hospitalizations across the country. These flexibilities include allowances for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers (ASCs) to provide greater inpatient care when needed
• New reports show increase in home health referrals during pandemic
• CMS announced that it will retire the original compare tools Dec. 1. Released in early September, Care Compare at Medicare.gov replaces the original compare tools, including Nursing Home Compare, Hospital Compare, and Physician Compare. See https://www.medicare.gov/care-compare/
• CMS Urging Nursing Homes to Follow Established COVID Guidelines This Holiday Season. Today, in advance of the approaching holiday season, the Centers for Medicare & Medicaid Services (CMS) is urging nursing home staff, residents and visitors to follow established guidelines for visitation and adherence to the core principles of infection prevention.
  

Posted October 2020

Clinical

• The program rule on Interoperability, Information Blocking, and ONC Health IT Certification, which implements the 21st Century Cures Act passed in 2016, requires patients be provided access to all the health information in their electronic medical records without charge by their healthcare provider beginning November 2, 2020.
  
• Fierce Health IT Virtual Series - Telehealth's Takeover
• Assessment of role of PRP in management of diabetic foot ulcers- A clinical study
• Risk factors for lower extremity amputation in patients with diabetic foot ulcers: A meta-analysis
• Silver dressings for the healing of venous leg ulcer. A meta-analysis and systematic review
  

Reimbursement

• CMS Further Expands Telehealth. On October 14, 2020, CMS announced further changes to expand telehealth coverage. Eleven (11) new codes have been added to their list of covered services bringing the current total to 144 services. The list of these newly added services is available at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes. The new services include some neurostimulator analysis and programming services as well as some cardiac and pulmonary rehabilitation services. CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. “Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country,” said CMS Administrator Seema Verma. Between mid-March and mid-August 2020, over 12.1 million Medicare beneficiaries – over 36 percent – of people with Medicare Fee-For-Service have received a telemedicine service. To view the Medicaid and CHIP data snapshot on telehealth utilization during the PHE, please visit: https://www.medicaid.gov/resources-for-states/downloads/medicaid-chip-beneficiaries-COVID-19-snapshot-data-through-20200630.pdf
• CMS Clarification of Patient Discharge Status Codes and Hospital Transfer Policies 
• Revised 10/16 Medicare Fee-For-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19): "We revised the article to clarify the HCPCS codes that Critical Access Hospitals (CAHs) should use in the Families First Coronavirus Response Act Waives Coinsurance and Deductibles for Additional COVID-19 Related Services section. Also, we clarified the Skilled Nursing Facility (SNF) Benefit Period Waiver - Provider Information section to show the SNF waiver applies to swing-bed services in rural hospitals and CAHs. All other information remains the same."

Posted September 2020

Clinical

• Cutting-Edge Methods for Delivering Expert WOC Care Telehealth, Telemedicine, and Complementary Models (Journal of Wound, Ostomy and Continence Nursing, paid)
• COVID-19 data provided by CMS: Preliminary Medicare COVID-19 Data Snapshot
• Effects of hyperbaric oxygen on graft survival outcomes in composite grafting for amputated fingertip injury
• Epidemiology, Clinical Features, Diagnosis, and Treatment of Cerebral Mucormycosis in Diabetic Patients: A Systematic Review of Case Reports and Case Series
  

Reimbursement

• Novitas and FCSO retired their HBOT local coverage determinations on 8/27/20. See topic "Medicare Coverage Determinations for Hyperbaric Oxygen Therapy"

Quality

• Medicare Promoting Interoperability Program vs. MIPS Promoting Interoperability Performance Category Fact Sheet 
  
• The Confidential Dry Run Reports containing FY 2018 and FY 2019 performance scores for the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations measure are now available
  
• CMS Quality Measures:How They Are Developed, Used, & Maintained
• One Week Remaining to Submit MIPS Targeted Review Requests. The deadline to submit your request is October 5, 2020 at 8:00 p.m. (EDT). If you participated in the Merit-based Incentive Payment System (MIPS) in 2019, your performance feedback, including your MIPS final score and payment adjustment factor(s), is now available for review on the Quality Payment Program website. This final score determines the payment adjustment you will receive in 2021, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished by a MIPS eligible clinician in 2021. QPP Login
  

Posted August 2020

Clinical

• UHMS and ACHM Position Statement: Hyperbaric Oxygen (HBO2) for COVID-19 Patients - by Caroline Fife, M.D. | Aug 13, 2020 | COVID-19, COVID-19 & HBOT:  The Undersea and Hyperbaric Medical Society (UHMS) and the American College of Hyperbaric Medicine (ACHM) have endorsed an updated position statement on the use of HBO2 for COVID-19 pneumonia (follow this link for the full statement).

Reimbursement

• COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing (updated on 8/26/20)
  
• CMS Releases Hospital Telemedicine Billing Decision Tree (See Section LL. Hospital Billing for Remote Services)
  
• Executive Order on Improving Rural Health and Telehealth Access - Rural healthcare providers, in particular, need these types of flexibilities to provide continuous care to patients in their communities.  It is the purpose of this order to increase access to, improve the quality of, and improve the financial economics of rural healthcare, including by increasing access to high-quality care through telehealth. See Section 5. Expanding Flexibilities Beyond the Public Health Emergency. 
  " Within 60 days of the date of this order, the Secretary shall review the following temporary measures put in place during the PHE, and shall propose a regulation to extend these measures, as appropriate, beyond the duration of the PHE: (a)  the additional telehealth services offered to Medicare beneficiaries; and(b)  the services, reporting, staffing, and supervision flexibilities offered to Medicare providers in rural areas."
• Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021: On August, 3 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021. 
• Proposed Updates to the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Year 2021: On August 12 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Year 2021.

Posted July 2020

Announcement

• RATIONALE, STUDY DESIGN CONSIDERATIONS, AND PROTOCOL RECOMMENDATIONS FOR TREATING COVID-19 PATIENTS WITH HYPERBARIC OXYGEN: Posted July 28, 2020 at UHMS.org - The UHMS Research Committee has completed their "Rationale, Study Design Considerations, and Protocol Recommendations for Treating Covid-19 Patients with Hyperbaric Oxygen" report.  As SARS-CoV-2 infection accelerated in early 2020, many patients deteriorated rapidly and became ventilator-dependent. The death rate from serious infection was frightening, especially in patients with other chronic diseases. Clinicians and medical researchers began developing strategies to treat and prevent this new worldwide public health threat. They looked to novel interventions because no highly effective therapies existed, and care was mostly supportive. Some recommended hyperbaric oxygen (HBO2) therapy because of its demonstrated success in providing oxygen and reducing end-organ damage in patients with severe carbon monoxide poisoning or anemia. Read more
• HHS extended the public health emergency declared for the COVID-19 pandemic Thursday, according to a tweet from Secretary Alex Azar. Extending the PHE allows a number of regulatory changes that have been enacted to help providers manage outbreaks of the novel coronavirus to continue, including the rollback of telehealth restrictions that have eased access to virtual visits.
  
• Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs) - Posted July 2020 by CMS. Is CMS suspending most Medicare Fee-For-Service (FFS) medical review during the Public Health Emergency (PHE) for the COVID-19 pandemic? 
  
• Effective July 1, 2020, (as posted on the Undersea and Hyperbaric Medicine LinkedIn page) NBDHMT has approved the use of live-streaming in accordance with the following information and guidelines detailed in this letter. Please be sure the joint provider you attend an Introductory Course in Hyperbaric Medicine with has approval through UHMS and NBDHMT for live streaming before registering. A full listing of approved ICHM courses is on the UHMS website here: https://lnkd.in/e5E2w2F.  Currently, International ATMO and Wound Care Education Partners are approved to host live-streaming of their ICHM courses and meet all UHMS standards. Other joint providers are pending approval, so please email stacy@uhms.org for more up to date information. UHMS approval is separate from NBDHMT, so please check with both organizations, if applicable.

Compliance

• RAC Audits Expected During the COVID Pandemic - New post on medicaidlaw-nc by kemanuel: Even though the public health emergency (“PHE”) for the COVID pandemic is scheduled to expire July 24, 2020, all evidence indicates that the PHE will be renewed. I cannot imagine a scenario in which the PHE is not extended, especially with the sudden uptick of COVID.  Center for Medicare and Medicaid Services (CMS) has given guidance that the voluminous number of exceptions that CMS has granted during this period of the PHE may be extended to Dec. 1, 2020.
• Notice of Non-Compliance Related to Annual Payment Update. Quality Reporting Program: Non-Compliance Letters for FY2021 APU CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2019, which will affect their FY 2021 Annual Payment Update (APU).  Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 18, 2020.

Clinical 

• Vaccines for COVID-19. Part 1: The Good, the Bad, the Ugly - by Caroline Fife, M.D. | Jul 27, 2020 | COVID-19, Guest Blog by Dr. Marissa Carter: There are currently over 140 SARS-cov2 vaccine candidates. Many of those will likely fail at some point due to lack of funding, poor efficacy, or unacceptable side effects but it is hoped that sufficient number will complete phase III trials and be acceptable to the regulatory authorities. It’s understandable to hope that a vaccine might do more than protect us from COVID-19 pneumonia.
  
• Defining the Role of Hyperbaric Oxygen Therapy as an Adjunct to Reconstructive Surgery.: Surg Clin North Am. 2020 Aug;100(4):777-785. doi: 10.1016/j.suc.2020.04.003. Epub 2020 Jun 17. Review.  The discipline of reconstructive surgery has been slow to accept the role of hyperbaric oxygen therapy (HBOT) as an adjunct to surgery, despite clinical and experimental data showing potential benefits. Obstacles prevent this acceptance; one of the most potent is surgeon bias. 
  
• Five Things About Nursing Homes During COVID-19: On July 9, CMS shared Five Things About Nursing Homes During COVID-19, part of an ongoing series by HHS. Safeguarding the health and well-being of the most vulnerable and fragile Americans is a top priority for the Trump Administration. Watch to hear from Administrator Seema Verma about five things CMS is doing to stop the spread of coronavirus in nursing homes.
• COVID-19: Lessons from the Front Lines Call — July 17. Friday, July 17 from 12:30 to 2 pm ET. These calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration (FDA) Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians: Share your experience, ideas, strategies, and insights related to your COVID-19 response. There is an opportunity to ask questions. To Participate:
• Conference lines are limited; we encourage you to join via audio webcast
• Or, call 833-614-0820; Access Code: 3096434

Reimbursement

•  July 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS), including Status Indicator Changes for Certain Virtual Services 
• Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2021
  
• October 2020 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

Quality

• CY 2020 Updates to the Quality Payment Program
•  MIPS VALUE PATHWAYS starting with the 2021 MIPS performance period:  In the CY 2020 PFS proposed rule (84 FR 40735), CMS proposed to apply a new MVP framework beginning with the 2021 MIPS performance period/2023 MIPS payment year to simplify MIPS, improve value, reduce burden, help patients compare clinician performance, and better inform patient choice in selecting clinicians. As discussed in section III.K.3.a.(2) of this final rule, CMS is finalizing a modified proposal to define MVPs at § 414.1305 as a subset of measures and activities established through rulemaking.
• CMS intends to develop MVPs in collaboration with stakeholders that align with guiding principles that include simplification and clinician burden reduction. CMS intends to work with stakeholders to develop MVPs that account for variation in specialty, size, and composition of clinician practices. CMS also intends that MVPs would allow for a more cohesive participation experience by connecting activities and measures from the 4 MIPS performance categories that are relevant to a patient population, a specialty or a medical condition, reducing the siloed nature of the current MIPS participation experience. 
• For more details see MIPS Value Pathways
• Spring/Summer 2020 Quality Payment Program Exception Applications Window Opens: If you seek a Quality Payment Program Extreme and Uncontrollable Circumstances Exception or a Hardship Exception to the Promoting Interoperability performance category, you will be able to apply for this between Spring 2020 and December 31, 2020. 
• See "Quality Payment Program – COVID-19 Response" 

Posted June 2020

Announcement

• Senate HELP Committee Considers Permanent Changes to Telehealth Policies - Posted By HIPAA Journal on Jun 18, 2020: The Senate Health, Education, Labor, and Pensions (HELP) Committee is considering which of the 31 recent changes to telehealth policies should be kept in place when the COVID-19 national public health emergency comes to an end.
  
• June is Wound Healing Awareness Month! The ABWM Foundation has named June as Wound Healing Awareness Month (WHAM!).  This month is meant to recognize the challenges experienced by individuals whose lives are affected daily by chronic wounds and to bring awareness to the general public of the support given by certified wound specialists.  In addition to Wound Healing Awareness Month, we designate June 15 - June 19, 2020 as Certified Wound Care Specialists Week. This week celebrates all practitioners certified by the American Board of Wound Management which includes Certified Wound Care Associates ®, Certified Wound Specialists ® and Certified Wound Specialist Physicians ®.
• National Board of Diving & Hyperbaric Technology - June Monthly Briefing from the NBDHMT President - “CHT re-certification requires a minimum of nine of the minimum 12 Category A credits relate directly to any combination of hyperbaric operations, related technical aspects and chamber safety”.  Continuing education is mandatory for health care professionals and hyperbaric team members are no exception. Among other things, it affords exposure to new information, consolidates existing knowledge and introduces evolving standards. It is anticipated that the sum of all of this is maintenance of best patient care and related safety.
• Changes to CHRN Re-Certification Requirements - The Baromedical Nurses Association Certification Board (BNACB)  has made changes to the CHRN re-certification requirements.  Any CHRN, CHRNC or ACHRN will now be required to recertify by their expiration date, with no lapse. If recertification packages are received after the expiration date, they will be required to re-sit for the certification exam as well as pay all fees associated with retesting.
•  CMS issued Phase 1 recommendations to safely resume in-person care in areas with low incidence or relatively low and stable incidence of COVID-19 cases. 

Compliance - HIPAA 

• HHS’ OIG to Scrutinize HHS COVID-19 Response and Recovery Efforts - Posted By HIPAA Journal on May 28, 2020:  The HHS’ Office of Inspector General (OIG) has published a strategic plan for over
  

Reimbursement

• UnitedHealthcare Extending Temporary Telehealth Expansion and Reimbursement Through Sept. 30, 2020 - To help you deliver care and be reimbursed for telehealth services, for certain markets and plans we’re temporarily continuing to waive the Centers for Medicare & Medicaid Services (CMS) originating site requirement for members through Sept. 30, 2020.*
• Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules (MLN Matters 5/22/2020, Effective Date: June 12, 2020)
  
• ICD-10-PCS Official Guidelines for Coding and Reporting .  These guidelines should be used as a companion document to the official version of the ICD-10-PCS as published on the CMS website. The ICD-10-PCS is a procedure classification published by the United States for classifying procedures performed in hospital inpatient health care settings 2021
  
• COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing
  
• McKinsey predicts that as much as $250 billion of current U.S. healthcare spending could theoretically be virtualized.
• Medicare considering making telehealth expansion permanent, Verma says
• Medicare is reviewing whether to make telehealth waivers permanent.
• Waivers have expanded provider eligibility lists and available payment from Medicare.
• Hospitals are asking Congress to expand other federal telehealth programs. 
• UnitedHealthcare Provider COVID-19 End Date and Billing Reminders - The following resources will help you quickly reference the effective dates for UnitedHealthcare’s temporary benefit, program and procedure changes related to COVID-19, as well as billing guidelines for services such as COVID-19 testing, treatment and telehealth. 
• Rapid Changes To Health System Spurred By COVID Might Be Here To Stay (Kaiser Family Foundation)
• Society Is Reopening. Prepare To Hunker Down At Home Again. (Kaiser Family Foundation)
• Telehealth and Virtual Services - During COVID 19 Webinar - June 25, 2020. (Noridian)This event includes: Telehealth Information, Waiver Changes, Eligible Providers, Hospice Attending, Service Listing, Other Telecommunicaton Services, Question and Answers Read the complete update
  

Clinical

• COVID-19 Has Made the Office Visit a Dinosaur: By IHI Multimedia Team | Wednesday, June 24, 2020 - The office visit has been central to modern medicine. Long-held truths include the necessity of meeting with patients in person, lining up patients to see them in order, and care team members efficiently doing their part to maximize the physician’s precious time and skills. COVID-19 has shown that this choreography is often unnecessary.
• Tracking COVID-19
• New Global Confirmed Cases (on 6/9): 117,052
• New U.S. Confirmed Cases (on 6/9): 18,061
• Total U.S. Deaths (as of 6/9): 112,311

• Moscow hospital uses hyperbaric oxygenation to treat COVID-19 patients - MOSCOW, June 5. /TASS/. Moscow’s Research Institute of Emergency Care (Sklifosovsky Institute) has begun experiments to use hyperbaric oxygenation therapy (HBOT) to treat COVID-19 patients, the Moscow mayor’s website said on Friday.
  
• Hyperbaric Oxygen Therapy Eases Persistent Postconcussion Symptoms - Medscape: Megan Brooks June 04, 2020 - "This study is the culmination of 31 years of clinical treatment and research on hyperbaric oxygen for TBI," lead investigator Paul Harch, MD, clinical professor of medicine, Louisiana State University Health Sciences Center, New Orleans, told Medscape Medical News.
• Influences of Hyperbaric Oxygen on Blood Pressure, Heart Rate and Blood Glucose Levels in Patients With Diabetes Mellitus and Hypertension: Noori S Al-Waili et al., PMID: 17045116  DOI: 10.1016/j.arcmed.2006.05.009. - 
• Hyperbaric Oxygen Therapy for Post-Stroke Depression: A Systematic Review and Meta-Analysis - Xin-Xin Liang, You-Guo Hao, Xue-Ming Duan, Xiu-Lan Han, Xiu-Xia Cai, PMID: 32474256  DOI: 10.1016/j.clineuro.2020.105910.  Post-stroke depression (PSD) is common consequence of stroke. However, today the majority of PSD patients remains untreated or inadequately treated, especially in the developing countries.

Posted May 2020 

Compliance - HIPAA

• Temporary Compliance Options for Code Modifications, Alternate Care Sites, and Facilities Related to Health Care - Posted by the NFPA.org - ADJUSTMENTS TO REGULATION: In the last three weeks of March 2020, CMS suspend-ed some of the normally mandated life safety code and emergency preparedness surveys at acute care hospitals, long-term care facilities, and ambulatory health care occupancies, among others. 
  
• CISA Issues Fresh Alert About Ongoing APT Group Attacks on Healthcare Organizations - The latest warning from the Department of Homeland Security (DHS) Cybersecurity and Infrastructure Security Agency (CISA) and the UK’s National Cyber Security Centre (NCSC) follows on from an earlier joint alert issued on April 8, 2020 and provides further information on the tactics, techniques, and procedures being used by the APT groups to gain access to networks and sensitive data.
  
• NSA Cybersecurity Guidance for Teleworkers and Other Useful COVID-19 Threat Resources - Posted By HIPAA Journal on May 1, 2020 - The National Security Agency has issued cybersecurity guidance for teleworkers to help improve security when working remotely. The guidance has been released primarily for U.S. government employees and military service members, but it is also relevant to healthcare industry workers providing telehealth services from their home computers and smartphones.
  
• AHA and AMA Release Joint Cybersecurity Guidance for Telecommuting Physicians - Posted By HIPAA Journal on Apr 17, 2020 - The American Medical Association (AMA) and the American Hospital Association (AHA) have issued joint cybersecurity guidance for physicians working from home due to the COVID-19 pandemic to help them secure their computers, mobile devices, and home networks and safely provide remote care to patients.

Reimbursement

• Healthcare Providers: Preparing for the next normal after COVID-19
  
• Telehealth Video: Medicare Coverage and Payment of Virtual Services - This update video provides answers to common questions about the expanded Medicare telehealth services benefit under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.
  
• Noridian Webinar: How to enroll your provider during this pandemic? Provider Enrollment COVID-19 Updates Webinars - May 7 and 14, 2020
• See updated topic "Reimbursement for Telemedicine Services in Wound Care"

Clinical

• Guest Blogger Marissa Carter, PhD On COVID-19 and What Happens Next by Caroline Fife, M.D. | May 12, 2020 - What Happens Next for the USA?  While there are a great many more blogs to write about COVID-10 from my perspective, before we go any further, we need to have an in-depth discussion on the epidemiology of the virus, so some things that weren’t clear to you now will be, especially as we are going to incorporate many of these items in further discussion.
• Respiratory conditions in coronavirus disease 2019 (COVID-19): Important considerations regarding novel treatment strategies to reduce mortality. - A novel virus named 2019 novel coronavirus (2019-nCoV/SARS-CoV-2) causes symptoms that are classified as coronavirus disease (COVID-19). Respiratory conditions are extensively described among more serious cases of COVID-19, and the onset of acute respiratory distress syndrome (ARDS) is one of the hallmark features of critical COVID-19 cases. 
  
• Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify - Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections 1814(a) and 1835(a) of the Social Security Act to allow Nurse Practitioners (NPs), certified Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) to certify beneficiaries for eligibility under the Medicare home health benefit and oversee their plan of care. This is a permanent change that will continue after the Public Health Emergency. Effective for claims with dates of service on or after March 1, 2020, these non-physician practitioners may bill the following codes:
• G0179: Physician re-certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care
  
• G0180: Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care
  
• G0181: Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans
• The descriptors of the three codes will be revised at a later date to include the non-physician practitioner specialties.
• HBOT in a Tyson COVID-19 Outbreak, Part 4: "I Can’t Stop Smiling" - by Caroline Fife, M.D. | May 7, 2020 | COVID-19, COVID-19 & HBOT 
• HBOT in a Tyson COVID-19 Outbreak, Part 3 - by Caroline Fife, M.D. | May 6, 2020 | COVID-19, COVID-19 & HBOT 
• HBOT in a Tyson COVID-19 Outbreak, Part 2: “It’s Incredible” - by Caroline Fife, M.D. | May 5, 2020 | COVID-19, COVID-19 & HBOT
• HBOT in a Tyson COVID-19 Outbreak, Part 1: Keeping it Real  - by Caroline Fife, M.D. | May 4, 2020 | COVID-19, COVID-19 & HBOT

Posted April 2020

Compliance - HIPAA

• AHA and AMA Release Joint Cybersecurity Guidance for Telecommuting Physicians - Posted By HIPAA Journal on Apr 17, 2020 - The American Medical Association (AMA) and the American Hospital Association (AHA) have issued joint cybersecurity guidance for physicians working from home due to the COVID-19 pandemic to help them secure their computers, mobile devices, and home networks and safely provide remote care to patients.
  
• WHAT PHYSICIANS NEED TO KNOW Working from home during COVID-19 pandemic - Posted by AMA and AHA at ama-assn.org - Many electronic health record (EHR) systems allow you to connect over the Internet just as if you were in the clinic. While you are doing your part to help during the COVID-19 pandemic, the American Medical Association (AMA) and American Hospital Association (AHA) want to ensure you have resources to help keep your work environment safe from cyber-threats that could disrupt your practice, the hospital, or negatively impact your patients’ safety and well-being.
  
• Zoom Security Problems Raise Concern About Suitability for Medical Use - Several privacy and security issues have recently been identified in the Zoom teleconferencing platform, which is currently being used by many healthcare providers for telehealth services during the COVID-19 public health emergency.
  
• Notice of Enforcement Discretion for Business Associates to Allow PHI Disclosures for Public Health and Health Oversight Activities - OCR has issued a Notice of Enforcement Discretion and will not impose financial penalties for good faith uses and disclosures of protected health information by business associates for public health and health oversight activities.
  

Reimbursement

• BRIEF - CMS rolls back more Medicare, telehealth regs for providers working through pandemic - Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic.
  
• UnitedHealthcare Provider news - COVID-19 Telehealth Services. Starting March 18, 2020, UnitedHealthcare expanded our policies around telehealth services for Medicare Advantage, Medicaid, and Individual and Group Market health plan members. In addition, effective from March 31, 2020 until June 18, 2020, we will also waive cost sharing for in-network telehealth visits for medical, outpatient behavioral and physical, occupational and speech therapy services (PT/OT/ST), with opt-in available for self-funded employers. UnitedHealthcare is waiving the Centers for Medicare and Medicaid’s (CMS) originating site restriction and audio-video requirement for Medicare Advantage, Medicaid, and Individual and Group Market health plan members from March 18, 2020 until June 18, 2020The following scenarios are intended as a guide to help you understand how UnitedHealthcare will reimburse telehealth services during the COVID-19 emergency period.
  
• Immediate infusion of $30 billion into healthcare system - CARES Act Provider Relief Fund - Recognizing the importance of delivering funds in a fast and transparent manner, $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American healthcare system. These are payments, not loans, to healthcare providers, and will not need to be repaid.
  
• Knicole Emanuel Appears on the Hospital Finance Podcast – Suspension of Audits. Blog, Covid-19, The Hospital Finance Podcast® Michael Passanante. Knicole C. Emanuel is a partner in the Raleigh office of Potomac Law Group and a member of the Health Care practice group. For more than 18 years, Ms. Emanuel has maintained a litigation practice, concentrating on Medicare and Medicaid litigation, health care regulatory compliance, administrative law and regulatory law.
  
• Billing for Professional Telehealth Services During the Public Health Emergency - Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. When billing professional claims for non-traditional telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with the Place of Service (POS) equal to what it would have been in the absence of a PHE, along with a modifier 95, indicating that the service rendered was actually performed via telehealth.
  
• Medicare Telehealth: Clinicians can now provide more services to beneficiaries via telehealth so that clinicians can take care of  their patients while mitigating the risk of the spread of the virus. Under the public health emergency, all beneficiaries across the country can receive Medicare telehealth and other communications technology-based services wherever they are located. Clinicians can provide these services to new or established patients. In addition, providers can waive Medicare copayments for these telehealth services for  beneficiaries in Original Medicare.  To enable services to continue while lowering exposure risk, clinicians can now provide the following  additional services by telehealth: 
• Emergency Department Visits, Levels 1-5 (CPT codes 99281-99285)
• Initial and Subsequent Observation and Observation Discharge Day Management (CPT codes  99217- 99220; CPT codes 99224- 99226; CPT codes 99234- 99236) 
• Initial hospital care and hospital discharge day management (CPT codes 99221-99223; CPT  codes 99238- 99239)
• Initial nursing facility visits, All levels (Low, Moderate, and High Complexity) and nursing facility discharge day management (CPT codes 99304-99306; CPT codes 99315-99316) 
• Critical Care Services (CPT codes 99291-99292) 
• Domiciliary, Rest Home, or Custodial Care services, New and Established patients (CPT codes  99327- 99328; CPT codes 99334-99337) 
• Home Visits, New and Established Patient, All levels (CPT codes 99341- 99345; CPT codes  99347- 99350) 
• Inpatient Neonatal and Pediatric Critical Care, Initial and Subsequent (CPT codes 99468- 99473;  CPT codes 99475- 99476)
• Initial and Continuing Intensive Care Services (CPT code 99477- 994780) 
• Care Planning for Patients with Cognitive Impairment (CPT code 99483) 
• Psychological and Neuropsychological Testing (CPT codes 96130- 96133; CPT codes 96136- 96139) 
• Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161- 97168; CPT codes  97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507) 
• Radiation Treatment Management Services (CPT codes 77427) 
• Licensed clinical social worker services, clinical psychologist services, physical therapy services,  occupational therapist services, and speech language pathology services can be paid for as  Medicare telehealth services.
• A complete list of all Medicare telehealth services can be found here. For more updates on reimbursement during the COVID pandemic, see topic "Reimbursement for Telemedicine Services in Wound Care"
• Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (4/6/20) [CMS-1744-IFC]   
• Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19
• Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit
• Home Health Agencies: CMS Flexibilities to Fight COVID-19
• Medicare Telehealth Frequently Asked Questions (FAQs) March 17, 2020

Clinical

• The Efficacy of N-Butylphthalide and Dexamethasone Combined with Hyperbaric Oxygen on Delayed Encephalopathy After Acute Carbon Monoxide Poisoning.  Carbon monoxide (CO) poisoning is a common health problem among people in many countries, primarily because of its severe clinical effects and high toxicological morbidity and mortality. Acute brain injury and delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) are the most common neurological complications. 
  
• Synopsis: UHMS Hyperbaric Oxygen Therapy Committee Meeting on COVID-19 and HBO2. This is a synopsis of a conference call between invited members of the Hyperbaric Oxygen Therapy committee, the American College of Emergency Physicians’ Section on Undersea and Hyperbaric Medicine, and invited researchers with clinical trials on the use of HBO2 and COVID- 19. This is a synopsis of the discussion curated from a recording of the meeting.
• UHMS Position Statement: Hyperbaric Oxygen (HBO2) for COVID-19 Patients - Date created: April 8, 2020 - There have been numerous recent inquiries regarding use of hyperbaric oxygen (HBO2) for patients with COVID-19. Questions have been raised pertinent to two possible mechanisms for HBO2 in this clinical context:  support of oxygenation and attenuation of pulmonary inflammation.  Based on a review of the current literature, discussion with hyperbaric researchers working on this topic, and senior UHMS members, the following conclusions and recommendations are provided.
• Centers for Medicare & Medicaid Services (CMS) Recommendations Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare: Phase I - To expand capacity to care for these patients and to conserve adequate staff and supplies, especially personal protective equipment (PPE), on March 18 the Centers for Medicare & Medicaid Services (CMS) recommended limiting non-essential care and expanding surge capacity into ambulatory surgical centers and other areas. However, CMS recognizes that at this time many areas have a low, or relatively low and stable incidence of COVID-19, and that it is important to be flexible and allow facilities to provide care for patients needing non-emergent, non-COVID-19 healthcare.
  
• Local Resumption of Elective Surgery Guidance. The guidelines published by the American College of Surgeons on their website on April 17, 2020, which emphasizes that healthcare systems consider appropriate timing for resuming elective operations and take steps to prepare equipment and facilities, assess workforce staffing and prioritize cases.
  
• A double-blind placebo-controlled clinical trial testing the effect of hyperbaric oxygen therapy on brain and cognitive outcomes of mildly cognitively impaired elderly with type 2 diabetes: Type 2 diabetes (T2D) is a risk factor for dementia. Ischemia due to vascular pathology is hypothesized to be an underlying mechanism for this association. 
• How Many Times Can an N95 Mask Be Sanitized and Reused? — Number of safe reuses varies by decontamination method, study states by Crystal Phend, Senior Editor, MedPage Today April 15, 2020 - N95 respirators can be safely decontaminated without undermining functional integrity only two or three times, a government study showed. Both ultraviolet light and vaporized hydrogen peroxide met the bar for killing off SARS-CoV-2 virus that causes COVID-19 without impacting fit testing for two rounds of wear and decontamination compared with control respirators.
• Statement from the Alliance of Wound Care Stakeholders - Wound Care is an Essential – Not Elective – Service that Prevents Hospital Admissions and ED Visits Among a Fragile Cohort of Patients at High-Risk of COVID-19. The rapidly evolving COVID-19 pandemic in the United States has hospitals and acute care facilities changing standard operating procedures to prepare for the expected influx of infected patients. As a result, services, procedures, and surgeries that are deemed “non-essential” are being shut down immediately, without thorough consideration of the ramifications.
• In response to the national emergency that was declared concerning the COVID-19 outbreak, a new diagnosis code, U07.1, COVID-19, has been implemented, effective April 1, 2020.
• Hyperbaric Oxygen Therapy for Severe COVID-19 Pneumonia? A blog post from Carolinefifmd.com by Caroline Fife, M.D. | Apr 4, 2020 
• Demonstration report on inclusion of hyperbaric oxygen therapy in treatment of COVID-19 severe cases - Naval Specialty Medical Center Program Team - Clinical reports and pathologic anatomic findings shown, progressive hypoxemia is the main cause of deterioration in patients with COVID-19."The mortality rate of critical patients in WuHan is close to 60%, and we are trying to solve the problem of hypoxia," Zhong Nanshan said on 27th Feb. HBOT is the strongest non-invasive oxygen therapy. 
• Message from the battlefield - pass this on to physicians treating COVID-19 patients 

Clinical Trials

• Safety and Efficacy of Hyperbaric Oxygen for Improvement of Acute Respiratory Distress Syndrome in Adult Patients With COVID-19; a Randomized, Controlled, Open Label, Multicentre Clinical Trial  Brief Summary: We hypothesize that hyperbaric oxygen (HBO) is safe for patients with COVID-19 and that HBO reduces the inflammatory reaction in Acute Respiratory Distress Syndrome (ARDS) associated with COVID-19. Also known as SARS-CoV-2, COVID-19 is declared a pandemic by World Health Organization (WHO). No specific treatment has been successful as of March 2020. Mortality rates in patients that develop ARDS is extremely high, 61.5-90%, almost double the mortality of ARDS of any cause. ARDS associated with COVID-19 is associated with pulmonary edema, rapidly progressing respiratory failure and fibrosis. The mechanism behind the rapid progress is still an enigma but theories have evolved around severe inflammatory involvement with a cytokine storm. Macrophage activation is involved in the early phase of ARDS and cytokine modulators have been tried in experimental settings without proven clinical benefits. HBO significantly reduces inflammatory cytokines and and oedema in other clinical settings. HBO has been used for almost a century, nowadays mainly used for its anti-inflammatory effects. Several randomized clinical trials show beneficial effects in variety of inflammatory diseases including diabetic foot ulcers and radiation injury. HBO is generally regarded as safe with very few adverse events and extensive experimental and clinical evidence suggest that HBO is a promising drug to ameliorate ARDS associated with COVID-19.
• Hyperbaric Oxygen for COVID-19 Patients - NIH U.S. National Library of Medicine, Clinical Trials.gov -  Brief Summary: Hyperbaric oxygen therapy (HBOT) treatment will be provided to patients as an adjunct to standard therapy for a cohort of 40 COVID19-positive patients with respiratory distress at NYU Winthrop Hospital. All patients prior to the clinical application of HBOT will be evaluated by the primary care team and hyperbaric physician. After the intervention portion of this study, a chart review will be performed to compare the outcomes of intervention patients versus patients who received standard of care.

Quality

• CMS flexibilities to fight COVID-19 (3/30/20) Changes to MIPS:  CMS is making two updates to the Merit-based Incentive Payment System(MIPS) in the Quality Payment Program. CMS is modifying the MIPS Extreme and Uncontrollable Circumstances policy to allow clinicians who have been adversely affected by the COVID-19 public health emergency to submit an application and request reweighting of the MIPS performance categories for the 2019 performance year. This is an important change that allows clinicians who have been impacted by the COVID-19 outbreak and may be unable to submit their MIPS data during the current submission period, to request reweighting and potentially receive a neutral MIPS payment adjustment for the 2021 payment year. Additionally, CMS is adding one new Improvement Activity for the CY 2020 performance year that, if selected, would provide high-weighted credit for clinicians within the MIPS Improvement Activities performance category. Clinicians will receive credit for this Improvement Activity by participating in a clinical trial utilizing a drug or biological product to treat a patient with COVID-19 and then reporting their findings to a clinical data repository or clinical data registry. This would help contribute to a clinicians overall MIPS final score, while providing important data to help treat patients and address the current COVID-19 pandemic.
  

Posted March 2020

Reimbursement

• 2020 Telehealth Expansion During Emergency Webinars - Medicare made changes to the telehealth guidelines for services provided during the COVID-19 emergency. WPS will hold two webinars to discuss these changes. Our education provides an overview of telehealth services and the CMS changes during the emergency. We will also discuss other communication technology-based services available. 

                            04/02/2020 - 8:30 AM - 10:00 AM CT (9:30 AM - 11:00 AM ET) Register at http://wpsghalearningcenter.com/confirm-course?courseid=7MZ-HsyrHdc1

                            04/09/2020 - 1:00 PM - 2:30 PM CT (2:00 PM - 3:30 PM ET) Register at http://wpsghalearningcenter.com/confirm-course?courseid=_o4jeWat3ho1

• CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19 - CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19.
  
• Provider Minute Video: The Importance of Proper Documentation - Why is proper documentation important to you and your patients? Find out how it affects items/services, claim payment, and medical review in the Provider Minute: The Importance of Proper Documentation video. Learn about: Top five documentation errors, How to submit documentation for a Comprehensive Error Rate Testing review, How your Medicare Administrative Contractor can help
• President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak - The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.
  
• MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET - Under President Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.
  
• For guidance on CMS reimbursement for diagnostic laboratory services, physician services (including telemedicine and telehealth), hospital services and drugs and vaccines under Medicare Part B, see CMS Covid-19 FAQ (3/9/20)
• Highlighted telehealth benefits in the Medicare program for use by patients and providers. Expanded use of virtual care are important tools for keeping beneficiaries healthy, while helping to contain the community spread; see the fact sheet on coverage and payment related to COVID-19.
  

Clinical

• OCR Issues Guidance on Telehealth and HIPAA During Coronavirus Pandemic -Posted By HIPAA Journal on Mar 23, 2020 - Following on from the announcement from the HHS’ Office for Civil Rights that enforcement of HIPAA compliance in relation to the good faith provision of telehealth services during the COVID-19 nationwide public health emergency has been relaxed, OCR has issued guidance on telehealth and remote communications.
  
• The Treatment of Perioperative Spinal Cord Injury with Hyperbaric Oxygen Therapy: A Case Report. 
  
• HIPPA Compliance and COVID - 19.  HIPAA covered entities – healthcare providers, health plans, healthcare clearinghouses – and business associates of covered entities no doubt have many questions about HIPAA compliance and COVID-19 coronavirus cases.
• Alliance COVID-19 Response and Guidance - The rapidly evolving COVID-19 pandemic has hospitals and acute care facilities changing standard operating procedures to prepare for the expected influx of infected patients.
  
• CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Earlier today at the White House Task Force Press Briefing, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.
  
• General Provider Telehealth and Telemedicine Tool Kit - Intent of Toolkit: Under President Trump’s leadership to respond to the need to limit the spread of community COVID-19, the Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.
• EUROPEAN COMMITTEE FOR HYPERBARIC MEDICINE - ECHM position on Hyperbaric Oxygen Therapy (HBOT) in multiplace hyperbaric chambers during coronavirus disease (COVID-19) outbreak.
• Measurement of peripheral arterial tonometry in patients with diabetic foot ulcers during courses of hyperbaric oxygen treatment. Treatment of diabetic foot ulcers is complex and often protracted. Hyperbaric oxygen treatment (HBOT) improves wound healing in diabetic ulcers and serves as an important adjunct to regular diabetic wound care. 
  
• Hyperbaric oxygen treatment results in a group of Turkish central retinal artery occlusion patients with a combined presence of thrombophilic mutations. Central retinal artery occlusion (CRAO) is a rare ocular-ischemic syndrome causing irreversible blindness. Its pathophysiology has not been clarified, and no targeted therapies are available yet.
  
• COVID-19 Emergency Declaration Health Care Providers Fact Sheet The Trump Administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers combat and contain the spread of 2019 Novel Coronavirus Disease (COVID- 19). In response to COVID-19, CMS is empowered to take proactive steps through 1135 waivers and rapidly expand the Administration’s aggressive efforts against COVID-19.
  
• CMS Adult Elective Surgery and Procedures Recommendations: Limit all non-essential planned surgeries and procedures, including dental, until further notice. To aggressively address COVID-19, CMS recognizes that conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus.
• CMS Sends More Detailed Guidance to Providers about COVID-19 - CMS took action to protect the health and safety of our nation’s patients and providers in the wake of the 2019 Novel Coronavirus (COVID-19) outbreak. This includes clear, actionable information on the screening, treatment, and transfer procedures to follow when interacting with patients. 
• Acute phase treatment in central retinal artery occlusion: thrombolysis, hyperbaric oxygen therapy or both? Central retinal artery occlusion (CRAO) is a neuro-ophthalmological emergency. There is a finite time window for acute interventions such as revascularization (e.g. intravenous thrombolysis-IVT) and retinal oxygenation (e.g. hyperbaric oxygen therapy-HBOT) therapies.

Safety

• Don't Compromise Fire Safety While Responding to Coronavirus: Keep Fire Doors Operable - Blog Post created by kristin Bigda on Mar 9, 2020 - As incidents of the coronavirus have continued to climb in the U.S., you’d be hard-pressed to get through the past couple of weeks without hearing reports of its spread.
• With COVID-19 Gripping the Globe, NFPA Offers Resources for Emergency Planning, First Responder Precautions, and Fire, Life, and Electrical Safety - Blog Post created by jim Pauley  on Mar 16, 2020 - As the world grapples with the unprecedented health crisis known as COVID-19 or the coronavirus, NFPA, like many organizations, is monitoring the U.S. Centers for Disease Control and Prevention and other governmental sources for COVID-19 updates and adjusting business practices as recommended.

Posted February 2020

Reimbursement

• A Peek at Real World Use of Cellular and/or Tissue Based Product (CTP) Use – On the Eve of Episode-Based Payment. Recent Blog post by Caroline Fife, M.D. | Feb 19, 2020
  
• Attention all Undersea and Hyperbaric Medicine Specialists – You May Not Be Able to Order Home Health Services:  New post from CarolineFifeMD.com on 02/11/2020
  
• Adopting Telemedicine in Wound Care: Interprofessional Internet Consultations - Throughout the world, the use of telemedicine in chronic wound management has been associated with lower cost of care, shorter healing time, fewer foot amputations and fewer office visits.
• What is a Hierarchical Condition (HCC) Score and why should you CARE? Caroline Fife, MD guest Blog post by Helen Gelly, MD - Most people these days know their Credit Score. There are “apps” to check it and to improve it, even though it may be calculated in a complex way from a lot of factors. And even though the financial impact of a low credit score may be indirect, most people know it is real. There is another score that affects the financial health of medical practitioners, and that is their Hierarchical Condition (HCC) Score.Most people these days know their Credit Score. There are “apps” to check it and to improve it, even though it may be calculated in a complex way from a lot of factors. And even though the financial impact of a low credit score may be indirect, most people know it is real. There is another score that affects the financial health of medical practitioners, and that is their Hierarchical Condition (HCC) Score.
• AMA issues checklist for the transition to E/M office visit changes.  The AMA worked with the Centers for Medicare & Medicaid Services (CMS) and convened specialty societies and other health professionals to simplify the requirements, make them clinically relevant, and reduce excessive documentation burden.
• CMS Changes Wound Care & Hyperbaric Supervision Requirements: Or Did It? A recent Blog post by Valerie Short, RN, ACHRN, CWCN, CWS, CMBS, FACCWS, Director of Operations & Compliance National Baromedical Services, Inc.
• SNF Patient Driven Payment Model (PDPM) CMS' Fact Sheets

Quality

• QPP Website Now Includes 2020 MIPS Measures and Activities on the Explore Measures Tool
  
• Centers for Medicare & Medicaid (CMS) finalized changes to the Medicare Promoting Interoperability Program for eligible hospitals, critical access hospitals (CAHs), and dual-eligible hospitals attesting to CMS. The final rule adopted policies that will continue the advancement of certified EHR technology (CEHRT) utilization, further reduce burden, and increase interoperability and patient access to their health information. Changes for 2020 include:
• The Query of Prescription Drug Monitoring Program (PDMP) Measure will remain optional, be worth 5 bonus points, and will require a Yes/No attestation (retroactive to 2019).
• The Verify Opioid Treatment Agreement Measure has been removed.
• A reduction from 16 Clinical Quality Measures (CQMs) down to 8 total which are available to choose from, but participants must only report on 4 CQMs. The reporting period has also been changed to a self-selected calendar quarter.

Clinical

• Branch retinal artery occlusion in a patient undergoing Methotrexate therapy for ectopic pregnancy: A case report. 
  
• A systematic review and meta-analysis of hyperbaric oxygen therapy for diabetic foot ulcers with arterial insufficiency.
  
• Emergency Preparedness: Expect the Unexpected. The coronavirus that originated in the Chinese city of Wuhan has grabbed headlines over the past few weeks, as it sickened thousands and hundreds of people dead as of January 31.  
  

Posted January 2020

Reimbursement

• Late Night Thoughts on HBOT Prior Authorization – About the Centers for Medicare & Medicaid Services (CMS) Daily Digest Bulletin by Caroline Fife, M.D. | Jan 23, 2020 | Healthcare Payment Policy
• Quality Payment Program: New MIPS Participation Framework for 2021 Performance Period. CMS is implementing a new participation framework for the Merit-based Incentive Payment System (MIPS) starting with the 2021 performance period, MIPS Value Pathways (MVPs). The goal of this new framework is to move away from siloed performance category measures and activities and toward an aligned set of measures and activities that are more meaningful to clinicians and patient care.
• 2020 Physician Fee Schedules Revised - On December 20, 2019, the President signed the Further Consolidated Appropriations Act of 2020 (FCAA). The FCAA updates the CY 2020 Medicare Physician Fee Schedule (MPFS).
• Changes in the Level of Supervision of Outpatient Therapeutic Services in Hospitals and Critical Access Hospitals (CAHs): Effective January 1 2020, CMS has changed the minimum required level of supervision for hospital outpatient therapeutic services furnished by all hospitals and CAHs from direct supervision to general supervision. 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. This change ensures a standard minimum level of supervision for each hospital outpatient therapeutic service furnished incident to a physician’s service. As stated in the final rule with comment period, this change does not preclude a hospital from requiring a higher level of supervision for certain services, as it determines appropriate.
  
• Payment for Procedures Involving Skin Substitutes: For CY 2020, CMS finalized its proposal to continue the policy to assign skin substitutes to the low-cost or high-cost group, while CMS continues to consider comments received on episode-based payment or a single category of payment for services involving such products for future policy refinement.
  

Clinical

• Radiation Cystitis: Analysis of Compelling New Hyperbaric Research. A recent National Baromedical Services Blog post by Dick Clarke CHT, an extraction of his Letter to the Editors of UHM (2019 Vol 46),  
  
• Hyperbaric Oxygen Treatment for Carbon Monoxide Poisoning in Italy: Retrospective Validation of a Data Collection Tool for the Italian Registry of Carbon Monoxide Poisonings (IRCOP). 
  
• Investigational HBOT indications: Inflammatory bowel disease
  
• Radiation Proctitis: Hyperbaric Oxygen Enjoys Authoritative Recognition: Interesting Blog post from National Baromedical Services
  
• Decompression illness (DCI) in Finland 1999-2018: Special emphasis on technical diving. 
  
• Hyperbaric oxygen therapy in the prevention and management of tracheal and oesophageal anastomotic complications. 
  
• Reliability of the Dexcom G6 continuous glucose monitor during hyperbaric oxygen exposure. 
  

Posted December 2019

Reimbursement

• What’s the Difference Between Hyperbaric Registries? by Caroline Fife, M.D. | Dec 18, 2019 | Health Information Technology and Wound Care, US Wound Registry
• Effective 2020, CMS will reimburse 6 new telemedicine codes for Online Digital Evaluation Services (e-Visits): those are "patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office." 
• CPT codes 99421-23: time-based codes billed by physicians and qualified healthcare professionals for "Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days". Reimbursed in increments of 5-10 minutes (99421), 11-20 minutes (99422), and 21 or more minutes (99423)
• HCPCS codes G2061-63: similar to the CPT codes above, but can be billed by practitioners who cannot independently bill E/M services, for "Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days". Reimbursed in increments of 5-10 minutes (G2061), 11-20 minutes (G2062), and 21 or more minutes (G2063)
• Informed consent for telemedicine services: CMS is finalizing a policy to permit a single consent to be obtained for multiple interprofessional consultation services (99446-49, 99451, 99452), virtual check-ins and remote evaluation of recorded video and/or images. The policy will permit a single consent to be obtained for multiple services, rather than requiring consent to be obtained prior to each service.  Based on feedback from commenters, CMS believes an appropriate interval for the single consent is one year, and is finalizing that the single consent must be obtained at least annually.

Clinical

• Imaging-based predictors for hyperbaric oxygen therapy outcome in post-stroke patients.
• Diabetic Foot Ulcers: Appraising Standard of Care and Reviewing New Trends in Management. Diabetic foot ulcers (DFU) are one of the most common diabetes complications and are associated with significant morbidity and mortality. Current DFU standard of care (SOC) involves four principles.
  

Posted November 2019

Reimbursement

• Two new Price Transparency Requirements have been announced. One of the rules is the Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule. The second rule is the Transparency in Coverage Proposed Rule. Both the final and proposed rules require that pricing information be made publicly available.
  
• Physician Fee Schedule and OPPS/ASC Final Rules have been published  
• Bill Correctly for Medicare Telehealth Services. CMS released the Medicare Telehealth Services Video to help you bill correctly.
• Skilled Nursing Facility Claims Hold. As CMS has undertaken the implementation of the Patient Driven Payment Model (PDPM), we are holding a limited number of Skilled Nursing Facility (SNF) claims while we make further refinements to our claims processing system. PDPM is a historic reform of the SNF prospective payment system. PDPM focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment. PDPM was effective on October 1, 2019. Specifically, CMS is holding claims with:
• Dates of service October 1, 2019 or later and
• Type of Bill (TOB) inpatient services (21X) and swing bed services (18X) subject to SNF Patient Driven Payment Model (PDPM) and
• Multiple line items, Health Insurance Prospective Payment System (HIPPS) codes, with different rate codes (revenue code 0022).
• CMS Finalizes Calendar Year 2020 Payment and Policy Changes for Home Health Agencies. In November 2018, CMS finalized a new case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. The final rule with comment period also increases Medicare payments to home health agencies (HHAs) by an estimated 1.3 percent ($250 million) for calendar year (CY) 2020.
•  CMS is implementing the Patient-Driven Groupings Model (PDGM), a new case-mix payment methodology for home health services, which more accurately pays for home health services and focuses on patient needs by relying heavily on patient characteristics rather than volume of care. 
• CMS is addressing potential Medicare fraud by phasing out pre-payments for home health services over the next year and eliminating those payments completely in 2021.
• Final OASIS D-1 Data Submission Specifications Now Available
  

Quality

• Stay on Target with the Hospice Comprehensive Assessment Measure - One Pager Now Available. CMS has posted a document that articulates key information about the Hospice Comprehensive Assessment Measure. This one pager provides a visual to understand how the seven HIS measures contribute to the one Comprehensive Assessment Measure, and how to stay on target by completing all seven HIS measures for each patient. 
  
• The submission deadline for the Inpatient Rehabilitation Facility (IRF), Long-Term Care Hospital (LTCH), and Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) has been extended to November 18, 2019.

Clinical

• Efficacy of the additional effect of hyperbaric oxygen therapy in combination of systemic steroid and prostaglandin E₁ for idiopathic sudden sensorineural hearing loss.
  
• Random flap survival with hyperbaric oxygen: daily versus twice-daily treatments. 
  
• Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial
  
• The Centers for Medicare & Medicare Services (CMS) announced today the top 25 participants selected to advance to Stage 1 of the CMS Artificial Intelligence (AI) Health Outcomes Challenge. A key step in implementing President Trump’s Executive Order on Maintaining American Leadership in Artificial Intelligence, the CMS AI Health Outcomes Challenge will accelerate development of AI solutions that aid clinicians in predicting health outcomes and keeping patients healthy. CMS announced 25 Participants to advance to Stage 1 on October 30, 2019. 

Posted October 2019

Reimbursement

• CMS National Training Program - Understanding Medicare CEU Webinars October 15 & 16, 2019, 1:00 - 3:30 pm ET Part 1 and Part 2
• CMS will provide updates on current Medicare Fee-for-Service provider compliance topics. Register now to join the Center for Program Integrity - Provider Compliance Group for an interactive session on Medicare Fee-for-Service compliance. 
• Tuesday, November 12, 2019, 12:00 p.m. ET - 4:00 p.m. ET
• ICD-10 code updates are effective annually on October 1st.
• Centers for Medicare and Medicaid Services (CMS) released an update to the Medicare Beneficiaries at a Glance infographic with data for 2017. This infographic is a quick reference tool that presents a visual summary of key metrics for the Medicare population including information on types of coverage, utilization, average cost for specific services, top chronic conditions, beneficiary satisfaction and access to care, and usual source of care.
• Centers for Medicare and Medicaid Services (CMS) posted the first annual release of the Post-Acute Care and Hospice Utilization and Payment Public Use Files (herein known as “PAC PUF”) with data for 2017. The PAC PUF replaces the Home Health, Hospice, and skilled nursing facilities (SNF) Utilization and Payment PUFs released in past years. The PAC PUF presents summarized information on services provided to Medicare beneficiaries by 9,701 home health agencies, 4,254 hospices, 15,036 SNFs, 1,119 IRFs, and 410 LTCHs. The PAC PUF includes summarized information on nearly 16 million claims and over $74 billion in Medicare payments for 2017. It contains information on demographic and clinical characteristics of beneficiaries served, professional and paraprofessional service utilization, submitted charges, and payments at the provider, state, and national levels. Additionally, the PUF includes payment information at the payment system level for home health agencies, SNFs, and IRFs. CMS protects beneficiaries’ personal information in all public data releases.
  

Quality

• The Hyperbaric Oxygen Therapy Registry: Driving quality and demonstrating compliance.
• Learn More About MIPS and Earn CME Credit with These 2019 CME Modules. CMS has posted 6 continuing medical education (CME) modules on the Merit-based Incentive Payment System (MIPS).
• Quality Payment Program 2019 Overview – Provides information on the origin and objectives of the program as well as an overview of the MIPS and Advanced Alternative Payment Models.
• Quality Payment Program Merit-based Incentive Payment System (MIPS): Participation in 2019 – Details MIPS eligibility and participation options, including the new opt-in policy, and how to report MIPS data.
• Quality Payment Program Merit-based Incentive Payment System (MIPS): Quality Performance Category in 2019 – Explains the requirements, data submission and collection types, and scoring for the Quality performance category.
• Quality Payment Program Merit-based Incentive Payment System (MIPS): Promoting Interoperability Performance Category in 2019 – Provides information on reporting requirements, measures, and reweighting for the Promoting Interoperability performance category.
• Quality Payment Program Merit-based Incentive Payment System (MIPS): Improvement Activities in 2019 – Explains the requirements, reporting steps, and scoring for the Improvement Activities performance category.
• Quality Payment Program Merit-based Incentive Payment System (MIPS): Cost Performance Category in 2019 – Provides information on new measures, attribution, and scoring for the Cost performance category.
• QPP Participation Status Tool Now Includes Second Snapshot of 2019 Qualifying APM Participant and MIPS APMs Data
• Register for the Oct. 16 2019 MIPS Eligible Measures Applicability Process Webinar, Wednesday, October 16, 2019, Time: 2:00 – 3:30 p.m. ET
  
• CMS is providing notifications to Home Health Agencies that were determined to be out of compliance with Home Health Quality Reporting Program (HH QRP) requirements, which will affect their CY 2020 Annual Payment Update (APU). Non-compliance notifications are in the process of being mailed by the Medicare Administrative Contractors (MACs) and will be placed into agency CASPER folders in QIES on October 1, 2019.   Home Health Agencies that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 local time, November 1, 2019.  If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notification and on the Home Health Quality Reporting Reconsiderations and Exception & Extension
  
• Upcoming MIPS Important Dates and Deadlines:
• Thursday, October 3 – The last day to begin data collection for a continuous 90-day performance period for the Improvement Activities and and Promoting Interoperability  performance categories. Note: Most, but not all, improvement activities have a continuous 90-day performance period, but several improvement activities require completion of modules where there is a year-long or alternate performance period. The performance period is 90 days unless otherwise stated in the activity description.
• January 2, 2020 – 2019 MIPS performance period data submission window opens.
  
• March 31, 2020 – 2019 MIPS performance period data submission window closes.
• See blog article "MIPS in Wound Care and Hyperbaric Medicine"
• Home Health Preview Reports for January 2020 Refresh
• LTCH Provider Preview Reports: Review Your Data by October 11
• IRF Provider Preview Reports: Review Your Data by October 11
• Hospice Provider Preview Reports: Review Your Data by October 11
• Virtual Groups Election Period for MIPS 2020 Performance Period Now Open.  What is a Virtual Group? A virtual group is a combination of two or more Taxpayer Identification Numbers (TINs) assigned to: One or more solo practitioners (who are MIPS eligible clinicians); or One or more groups consisting of 10 or fewer clinicians (including at least 1 MIPS eligible clinician); or Both (solo practitioners and groups of 10 or fewer clinicians) that elect to form a virtual group for a performance period for a year
  

Clinical

• HBOT and Brain Injury
  
• Is there a role for hyperbaric oxygen therapy in the treatment of refractory wounds of rare etiology?
  
• 2019 International Prevention and Treatment of Pressure Ulcer/Injury: Clinical Practice Guideline will be launched on November 15-16 in Los Angeles, CA
  

Posted September 2019

Reimbursement

• Medical Policy Revision: Hyperbaric Oxygen Therapy: Effective December 10, 2019, Horizon BCBSNJ will change the way they consider certain professional claims based on revisions to our medical policy, Hyperbaric Oxygen Therapy.  Based on the submitted diagnosis code(s), information may be requested to help determine the medical appropriateness of the services represented by CPT® code 99183 or HCPCS code G0277. Following their review of medical record information, these services may be denied as not medically necessary.
  
• DMEPOS: Nationwide expansion of required PA of pressure reducing support surfaces: A Federal Register Notice (84 FR 16616) added five Pressure Reducing Support Surfaces codes to the Required Prior Authorization (PA) List. Effective October 21, all Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers in all states are required to obtain prior authorization
• Launch of the New CMS Beneficiary Notices Initiative (BNI) Mailbox Portal for Beneficiary Notices and Related Policy Questions: The site serves as a single portal for submitting questions about Part C & D Organization/Coverage Determinations, Appeals & Grievances and Beneficiary Notices Initiative (BNI)
  

Quality

• The Deadline to Submit a MIPS Targeted Review Request is less than 2 Weeks Away. You Have 2 Weeks to Submit a Targeted Review Request. If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are now available for review on the Quality Payment Program website. The MIPS payment adjustment you will receive in 2020 is based on your final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2020. MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request for CMS to review their performance feedback and final score calculation through a process called targeted review. The deadline to submit your request is September 30, 2019 at 8:00 PM (EDT)
• Inpatient Rehabilitation Facility (IRF) Provider Preview Reports have been updated and are now available.
• Long-Term Care Hospital (LTCH) Provider Preview Reports have been updated and are now available.
  

Clinical

• Retinal Artery and Vein Occlusions Successfully Treated with Hyperbaric Oxygen: Six cases of central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) recently treated with hyperbaric oxygen 
  
• Blood glucose levels in diabetic patients undergoing hyperbaric oxygen therapy.
  
• Calculated risk of pulmonary and central nervous system oxygen toxicity: a toxicity index derived from the power equation.
  
• Prophylactic negative pressure wound therapy for surgical site infection in obese women undergoing cesarean section: an evidence synthesis with trial Sequential Analysis.
  
• A single session of hyperbaric oxygen therapy demonstrates acute and long-lasting neuroplasticity effects in humans: a replicated, randomized controlled clinical trial.
  
• Seizure frequency in more than 180,000 treatment sessions with hyperbaric oxygen therapy - a single centre 20-year analysis.
  
• Arizona-led bill could allow for new treatment for vets with brain injuries
  
• Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial
  
• Understanding Nutritional Optimization in Hyperbaric Oxygen Therapy
  
• Pyoderma Gangrenosum (PG): Not So Rare, and When in Doubt, Take a History
• Early Magnetic Resonance Imaging for Patients With Idiopathic Sudden Sensorineural Hearing Loss in an Emergency Setting. The aim of this work is to relate early MR findings obtained immediately after the admission, with the clinical presentation, the audiological findings, and the outcomes of treatment.
  
• AHRQ Comparative Effectiveness of Analgesics To Reduce Acute Pain in the Prehospital Setting. As initial therapy in the prehospital setting:
• Nonsteroidal anti-inflammatory drugs provide similar pain relief to opioids and may cause fewer overall side effects and less drowsiness.
• Acetaminophen may provide similar pain relief to opioids, and may cause fewer side effects overall and less dizziness.
• Ketamine may provide similar pain relief to opioids. Ketamine may cause more dizziness or overall side effects, while opioids may cause more respiratory depression.
• Combining an opioid with ketamine may be more effective in reducing pain compared with opioids alone.
• If morphine does not adequately relieve pain, changing to ketamine may be more effective and more quickly reduce pain than giving additional morphine.

Posted August 2019

• Centers for Medicare & Medicaid Services Special Open Door Forum Open Payments Expansion under the SUPPORT Act Thursday, August 29, 2019 2:00pm – 3:00pm Eastern Time Conference Call Only.
• Open Payments is a national disclosure program that promotes a more transparent and accountable health care system by publishing the financial relationships between applicable manufactures and group purchasing organizations (GPOs) and health care providers (physicians and teaching hospitals).
• In the fall of 2018 President Trump signed the SUPPORT Act into law which expands the Open Payments definition of a covered recipient to include: physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives.

• CMS Proposes to Reverse E/M Stance to Align with AMA Revisions On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.”
  
• Home Health Patient-Driven Groupings Model: Operational Issues Call - August 21. Wednesday, August 21 from 1:30 to 3 pm ET. During this call, learn information to help your agency prepare to implement billing changes for the Patient-Driven Groupings Model (PDGM) on January 1, 2020. CMS will use the PDGM to reimburse home health agencies for providing home health services under Medicare fee-for-service.
• New Medicare Card: Will Your Claims Reject? Protect your patients’ identities by using the Medicare Beneficiary Identifier (MBI) now. Starting January 1, 2020, you must use the Medicare Beneficiary Identifier (MBI). Medicare will reject claims you submit with the Health Insurance Claim Number (HICN), with a few exceptions, and reject all eligibility transactions. 
• SNF PPS Patient Driven Payment Model: Get Ready for Implementation on October 1. On October 1, the new Patient Driven Payment Model (PDPM) is replacing the Resource Utilization Group, Version IV (RUG-IV) for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). PDPM improves the accuracy and appropriateness of payments by classifying patients into payment groups based on specific, data-driven patient characteristics, while simultaneously reducing administrative burden.
• New Hampshire Expands Medicaid Coverage for Telehealth, RPM Services. Beginning in 2020, the state's Medicaid program will cover remote patient monitoring and store-and-forward services and give primary care providers, pediatricians and other care providers more leeway to use telehealth.
  
• Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session Monday, August 12 from 1-2:30 pm ET
• OPPS and ASC Proposed Rule Listening Session Wednesday, August 14 from 2:30 to 4 pm ET
• Importance of Proper Documentation: Provider Minute Video. Why is proper documentation important to you and your patients? Find out how it affects items/services, claim payment, and medical review in the Provider Minute: The Importance of Proper Documentation 
• Physician Fee Schedule Proposed Policy, Payment, and Quality Provisions Changes for CY 2020. Public comments due by September 27. On July 29, CMS issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020. It includes: CY 2020 PFS rate setting and conversion factor, Medicare telehealth services, Payment for evaluation and management services, among others. Highlights:
• The proposed CY 2020 PFS conversion factor is $36.09, a slight increase above the CY 2019 PFS conversion factor of $36.04.
• Addition of telehealth services: HCPCS codes GYYY1, GYYY2, and GYYY3, which describe a bundled episode of care for treatment of opioid use disorders.
• To reduce burden, proposal includes broad modifications to the documentation policy so that physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse-midwives could review and verify (sign and date), rather than re-documenting, notes made in the medical record by other physicians, residents, nurses, students, or  other members of the medical team.  
• OPPS and ASC Payment System CY 2020 Proposed Rule. Public comments due by September 27. CMS is proposing to update OPPS payment rates by 2.7 percent. Highlights:
• Proposed requirements for making public consumer-friendly standard charges for a limited set of ‘shoppable services’
• High-cost/low-cost threshold for packaged skin substitutes
  
• Device pass-through applications
• Hospital Outpatient Quality Reporting Program
• CMS Advances MyHealthEData with New Pilot to Support Clinicians Pilot program gives clinicians direct access to claims data

Quality

• Hospice Compare Quarterly Refresh now available
  
• CMS is Bringing Health Plan Quality Ratings to All Exchanges for the First Time. Consumers will have improved access to health plan quality information for the 2020 Open Enrollment Period
  
• CMS Overall Hospital Star Ratings Listening Session on September 19, 2019. The session will also be broadcast via web conference line
• FY 2020 Quality Payment Program Proposed Rule Fact Sheet 
• New Episode of CMS: Beyond The Policy is Available: Episode 5: Nursing Home Strategy Part 1 – Strengthening Oversight
  
• IRF/LTCH/SNF QRP August 15, 2019 Submission Deadline Reminder. The submission deadline for the Inpatient Rehabilitation Facility (IRF), Long-Term Care Hospital (LTCH), and Skilled Nursing Facility (SNF) Quality Reporting Programs is approaching
  
• MIPS-Eligible Clinicians: Learn More about Reporting Patient Relationship Categories. CMS recently released a Medicare Learning Network (MLN) Matters article about reporting Patient Relationship Categories and Codes (PRC) on Medicare claims.
  

Clinical

• Changes in Skin Perfusion Pressure After Hyperbaric Oxygen Therapy Following Revascularization in Patients With Critical Limb Ischemia: A Preliminary Study. 
  
• The increasing threat of silver-resistance in clinical isolates from wounds and burns.: Plasmid-mediated silver-resistance was detected for the first time, in clinical P. aeruginosa, A. baumannii and S. aureus isolates; in addition to its detection in K. pneumoniae, E. coli and Enterobacter cloacae. Therefore, strict monitoring on the use of silver compounds in medical settings is required; with implementation of an approved standardized method for silver-resistance detection.
  
• Evaluation of the efficacy of lipotransfer to manage radiation-induced fibrosis and volume defects in head and neck oncology.
  
• How Telemedicine is Influencing Wound Care
• Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study. 

Posted July 2019

Reimbursement

• CGS Administrators (7/11/19): Revision of  Local Coverage Determination (LCD): Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities (L36690). Revision Explanation: All coding information removed based on CR 10901 and added to Local Coverage Article:  Billing and Coding: Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities (A56696)
• J5B-17N Hyperbaric Oxygen Therapy (HBO-T): Providers continue to see denials due to missing documentation. To see a list of the required documentation 
  
• New CMS Proposed Rules for Home Health. CY 2020 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; and Home Infusion Therapy Requirements.  CMS accepts comments by 5 p.m. on September 9, 2019. This proposed rule would update the home health prospective payment system (HH PPS) payment rates and wage index for CY 2020; implement the Patient-Driven Groupings Model (PDGM), a revised case-mix adjustment methodology, for home health services beginning on or after January 1, 2020. This proposed rule also implements a change in the unit of payment from 60-day episodes of care to 30-day periods of care, and proposes a 30-day payment amount for CY 2020. Additionally, this proposed rule proposes to: modify the payment regulations pertaining to the content of the home health plan of care; allow physical therapy assistants to furnish maintenance therapy; and change the split percentage payment approach under the HH PPS.
• Ask the Contractor Teleconference (ACT) - Telehealth Noridian, webinar on 07/24/19
• The 2020 ICD-10-CM files are now available. These 2020 ICD-10-CM codes are to be used for discharges occurring from October 1, 2019 through September 30, 2020 and for patient encounters occurring from October 1, 2019 through September 30, 2020.
  

Quality

• The Centers for Medicare & Medicaid Services (CMS) with the Physician Compare support team are hosting two one-hour webinars on the 2017 Quality Payment Program performance information recently published on Physician Compare. Tuesday, July 30, 2019 at 11:00 am ET / 8:00 am PT and Thursday, August 1, 2019 at 3:00 pm ET / 12:00 pm PT 
  
• CMS Releases Preliminary Data on 2018 Quality Payment Program Participation; 2017 QPP Performance Information is Now Available on Physician Compare
• New CMS Proposed Rules for Nursing Homes. Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency, and Transparency. CMS looks forward to feedback on the proposed rule and will accept comments until September 16, 2019.The proposed rule would eliminate prescriptive requirements and allow commonsense flexibilities.  For example, CMS proposes to eliminate unnecessary details of the Quality Assurance Improvement Program (QAPI) requirements while maintaining the overall structure and intent – improving patient outcomes.  This would help nursing homes implement more effective quality improvement programs. 
• IRF Quality Reporting Program: Non-Compliance Letters. CMS is providing notifications to facilities that were determined to be out of compliance with the quality reporting requirements for the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP), which will affect their FY 2020 Annual Increase Factor (AIF).
  
• SNF Quality Reporting Program: Non-Compliance Letters. CMS is providing notifications to facilities that were determined to be out of compliance with the quality reporting requirements for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP), which will affect their FY 2020 Annual Payment Update (APU).
  
• Hospice Quality Reporting Program Quarterly Update for 2nd Quarter of 2019 is Available
• Now Available: 2018 MIPS Performance Feedback and Final Score. Go to the QPP page
• Now Available: MIPS Targeted Review. If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are now available for review on the Quality Payment Program website. Go to the QPP page
• SNF QRP Provider In-Person Training Event, August 13 and 14, 2019

Clinical

• The American Telehealth Association Releases 2019 Update of State-by-State Telehealth Report Cards
  
• Asynchronous Telehealth Gives Providers An Alternative to DTC Video
  
• Hyperbaric oxygen therapy for the management of chronic wounds: patient selection and perspectives
  
• A Case Series of Hyperbaric oxygen Therapy for Central Artery Occlusion
• Sensible Decision Making
• Use of Thermal Imaging to Identify Deep-Tissue Pressure Injury on Admission Reduces Clinical and Financial Burdens of Hospital-Acquired Pressure Injuries

Posted June 2019

Reimbursement

• Clarification of billing and payment policies for Negative Pressure Wound Therapy (NPWT) using a disposable device
• Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
  
• President issues executive order on price transparency 
  
• Clarification of Billing and Payment Policies for Negative Pressure Wound Therapy (NPWT) Using a Disposable Device
  
• FUTURE Local Coverage Article: Wheelchair Seating - Policy Article (A52505)
  
• Understanding National and Local Coverage Determinations Webinar Tue, Jul 23, 2019 9:00 AM - 10:00 AM PDT
• Telehealth/Telemedicine Enrollment Only Webinar Wed, Jul 10, 2019 11:00 AM - 12:30 PM PDT
  
• Additional Documentation: Ways to Reduce Your Burden
• CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs
  
• Palmetto GBA Local Coverage Determination (LCD) update: Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication (L37774)
  
• The following Limited Data Set (LDS) file is now available: 2018 Home Health Claims OASIS Proposed

Quality

• AHRQ has released a new Network of Patient Safety Databases (NPSD), the first publicly available online resource that captures nonidentifiable information on patient safety events collected by AHRQ-listed Patient Safety Organizations 
  
• Webinar: Measuring Quality to Improve Quality: Strengths and Challenges of Clinical Quality Measurement Thursday, June 27 at 2:00-3:00 pm EST 
• Webinar: Patient-Centered Quality Measurement: What It Is and How to Get Involved Thursday, July 25 at 3:00-4:00 pm EST 
• Merit-based Incentive Payment System (MIPS) Data Validation and Audit to begin June 2019 for Performance Years 2017 and 2018
• 2017 MIPS Data Validation Criteria 
• 2018 MIPS Data Validation Criteria 
  
• Register Now for June 25 and 27 Webinars on Measuring Quality. Registration is open for webinars from the Centers for Medicare & Medicaid Services (CMS) titled Measuring Quality to Improve Quality: Strengths and Challenges of Clinical Quality Measurement
  
• Post-Acute Care QRPs: Reporting Requirements and Resources Call — June 5 Wednesday, June 5 from 2 to 3:30 pm ET
  
• Accountable Care Organizations More Likely To Use Home Visits To Help Manage Complex Patients’ Care. Home visits have been shown to improve care transitions following hospital discharge and enhance overall care management, and Medicare has created new reimbursement models to support home visits for some patients
• Patient Safety Essentials Toolkit, by the Institute for Healthcare Improvement
• CMS Hospice Provider Preview Reports Now Available
  

Clinical

• Hyperbaric oxygen therapy for iatrogenic arterial gas embolism after CT-guided lung biopsy : A case report
  
• Clinical utility of hyperbaric oxygen therapy in dentistry
  
• The Wounds With No Name… and the Patients Who Will Get No Care
  
• Lung function change in hyperbaric chamber inside attendants.
  
• Prophylactic Dressings for Pressure Injury Prevention: How Do They Work?
  
• The use of hyperbaric oxygen therapy in the treatment of necrotizing soft tissue infections, compromised grafts and flaps, hidradenitis suppurativa, and pyoderma gangrenosum. 
• Live Streaming of the ASM Pre-Course:Hyperbaric Oxygen Safety: Clinical and Technical Issues Wednesday, June 26, 2019: 8am-5:30pm
• Wound Care and hyperbaric Magazine Volume 10 Issue 2
  
• Impact of olive oil and honey on healing of diabetic foot: a randomized controlled trial.
  
• S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity
  
• Survey Results from the Gulf Region: NPUAP Changes in Pressure Injury Terminology and Definitions. 
  
• Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes
  
• Preventing pressure injury in nursing homes: developing a care bundle using the Behaviour Change Wheel
  
• Hyperbaric oxygen therapy as adjuvant therapy in necrotizing fasciitis of the face: case report. 
• Growth factors for diabetic foot ulcers: mixed treatment comparison analysis of randomized clinical trials.
  

Posted May 2019

Reimbursement

• Home Health (HH) Patient-Driven Groupings Model (PDGM) – Additional Manual Instructions — Revised
• The PDF file labeled “MDS 3.0 RAI Manual v1.17 October 1, 2019” is now available. Please note this early release is being provided in response to stakeholder feedback. The MDS 3.0 RAI Manual v1.17 contains many updates including information related to the Patient Driven Payment Model. Please check back prior to October 1, 2019 for a final posting which may contain additional updates.
  
• May 2019 Medicare Learning Network® (MLN) Catalog.The Catalog contains brief descriptions and links to trusted MLN educational resources for health care providers and professionals. 
• Hospital Outpatient Prospective Payment System Revised. Medicare Learning Network
• Medicare Billing: Form CMS-1500 and the 837 Professional Web-Based Training Course — Revised With Continuing Education Credit. A revised Medicare Billing: Form CMS-1500 and the 837 Professional Web-Based Training (WBT) course is available through the Medicare Learning Network Learning Management System. Learn about: Billing requirements, Claims processing actions, How to identify aspects of paper and electronic claims
• New Palmetto GBA Local Coverage Determination (LCD): Home Health Physical Therapy (L34564)
• Former CEO of Hospital Chain to Pay $3.46 Million to Resolve False Billing and Kickback Allegations
  
• CMS Advances Agenda to Re-think Rural Health and Unleash Medical Innovation Proposed changes to Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System would improve quality, expand access
• SNF PPS Patient Driven Payment Model: Get Ready for Implementation on October 1. On October 1, the new Patient Driven Payment Model (PDPM) is replacing Resource Utilization Group, Version IV for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
  

Quality

• Hyperbaric oxygen therapy as adjuvant therapy in necrotizing fasciitis of the face: case report.
  
• Using Health IT for Care Coordination: Insights From Six Medicare Accountable Care Organizations
  
• Webinar - Changing Tribal Demographics in Post-Acute Care (Wednesday, May 22, 2019 11:00 AM PDT - 12:00 PM PDT)
• The Medicare Promoting Interoperability Program Hardship Exception Application for Eligible Hospitals and Critical Access Hospitals is Now Available
  
• Register for May 23 Webinar on the MIPS Improvement Activities Performance Category in 2019
  
• Ensuring Safety and Quality in Nursing Homes.
  
• Post-Acute Care QRPs: Reporting Requirements and Resources Call 2019-06-05. During this call, learn about reporting requirements and resources for the Inpatient Rehabilitation Facility (IRF), Long-Term Care Hospital (LTCH), and Skilled Nursing Facility (SNF) Quality Reporting Programs (QRPs).
  
• IRF, LTCH, and SNF Quality Reporting Programs: Submission Deadline May 15
  
• Funding Applications Due May 25 and June 5 for Research Projects on Healthcare-Associated Infections and Antibiotic Resistance: AHRQ is seeking innovative research proposals for preventing healthcare-associated infections (HAI) and combating antibiotic-resistant bacteria (CARB).
  
• Join CMS on May 9 for the Advanced APMs Webinar: CMS is hosting a webinar on Thursday, May 9 at 2:00 PM ET to provide an overview of Advanced Alternative Payment Models—one of the two tracks of the Quality Payment Program.
• Nursing Home Compare Quarterly Refresh with SNF QRP Data Now Available
• IRF/LTCH/SNF QRP May 15, 2019 Submission Deadline Reminder. The submission deadline for the Inpatient Rehabilitation Facility (IRF), Long-Term Care Hospital (LTCH), and Skilled Nursing Facility (SNF) Quality Reporting Programs is approaching.
  

Clinical

• Successful treatment of brain radiation necrosis resulting from triple-negative breast cancer with Endostar and short-term hyperbaric oxygen therapy: a case report.
  
• Implementing TIMERS: the race against hard-to-heal wounds
  
• Potential of hyperbaric oxygen in urological diseases
  
• Advancing Patient-Centered Care for People With Multiple Chronic Conditions
  
• Increased Use of “Teach-Back” Method. The percentage of adults whose healthcare providers always initiated the “teach-back” method increased from about 24 percent in 2011 to 30 percent in 2015. Teach-back, an evidence-based way of confirming understanding, starts when providers ask patients to describe in their own words what their provider just told them. 
• Hyperbaric Oxygen Therapy Indications, 14th Edition by the Undersea and Hyperbaric Medical Society (UHMS), will be sold starting 5/16/19
• Essentials in the management of necrotizing soft-tissue infections.
  
• National Board of Diving and Hyperbaric Medical Technology monthly briefing - May 2019
• Operation of a hyperbaric oxygen therapy center in Korea: Report of our experience from a setting in its nascent stages.
  
• Middle ear barotrauma during hyperbaric oxygen therapy; a review of occurrences in 5,962 patients. 
• Cutaneous radiation damage: updating a clinically challenging concern. 
  
• Telehealth Consultations Might Improve Some Patient Outcomes: Patient outcomes generally improved in some areas of care when clinicians consulted other providers remotely for additional medical expertise, known as telehealth, according to an AHRQ-funded report.
• Hospital nurse-staffing models and patient- and staff-related outcomes.(paid)
• Pressure ulcers in patients receiving palliative care: A systematic review.(paid)
  

Posted April 2019

Reimbursement

• CMS Advances Agenda to Re-think Rural Health and Unleash Medical Innovation Proposed changes to Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System would improve quality, expand access
  
• A revised Telehealth Services Medicare Learning Network Booklet is available. Learn about: Requirements, Distant site practitioners, Billing and payment for the originating site facility
  
• UHMS member alert! CMS coverage of radiation proctitis
• Local Coverage Determination (LCD) update: Therapeutic Shoes for Persons with Diabetes
  
• Local Coverage Article update: Therapeutic Shoes for Persons with Diabetes - Policy Article
  
• Wisconsin Physicians Service Insurance Corporation: Local Coverage Determination (LCD) update: Wound Care (L37228)
• Wisconsin Physicians Service Insurance Corporation FUTURE Local Coverage Article (effective 5/13/2019): Wound Care Coding Companion for Wound Care L37228 (A55909)
  
• Palmetto GBA FUTURE Local Coverage Determination (LCD): Topical Oxygen Therapy (L37873)
• Centers for Medicare & Medicaid Services (CMS) is updating the “Medicare Program Integrity Manual” with detailed changes to the Local Coverage Determination (LCD) process.
  
• Home Health: Understanding OASIS Function M & GG Item Coding Fact Sheet

Quality

• U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced the CMS Primary Cares Initiative, a new set of payment models that will transform primary care to deliver better value for patients throughout the healthcare system
  
• Apply to Participate in the 2019 Factors Associated with Reporting Quality Measures Study & Get Improvement Activity Credit for 2019
• New 2019 MIPS Group Participation Guide Now Available on QPP Resource Library
• A revised Quality Payment Program Merit-based Incentive Payment System (MIPS): Quality Performance Category in 2019 Web-Based Training Course is available through the Medicare Learning Network Learning Management System 
  
• April 24 Webinar on 2019 MIPS Alternative Payment Models
  
• April 2nd is the Last Day to Submit MIPS Year 2 (2018) Data for the Quality Payment Program
  
• Who is eligible to participate in the Quality Payment Program?
• How to submit data for he Quality Payment Program? Please download and review the 2018 MIPS data submission FAQs 
  
• Home Health Quality Reporting Training
• What are the Home Health Start Ratings? What is the purpose of Quality of Patient Care Star Ratings and why did CMS add them to Home Health Compare (HHC) now?
  

Clinical

• Compression Stockings for the Prevention of Venous Leg Ulcer Recurrence: A Health Technology Assessment
  
• Subfascial endoscopic perforator surgery (SEPS) for treating venous leg ulcers
• The use of aloe vera in cancer radiation: An updated comprehensive review.
  
• Do diabetic patients who undergo transtibial amputation receive adequate treatment?
• Efficacy and Prognostic Factors of Combined Hyperbaric Oxygen Therapy in Patients With Idiopathic Sudden Sensorineural Hearing Loss.
  
• CMS finalizes policies to bring innovative telehealth benefit to Medicare Advantage
  
• CMS Pushes Telehealth, mHealth, But Are Providers Paying Attention?
  
• WCHM Magazine 10th Anniversary Issue - New Issue Now Available
  
• Boosting Telehealth Adoption. 77% of patients are willing to use virtual care

Posted March 2019

Reimbursement

• Hyperbaric Oxygen Therapy (HBO) J5 Targeted Probe and Educate (TPE): Round One Results
  
• The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers from all Medicare cards by April 2019. A new, randomly generated Medicare Beneficiary Identifier, or MBI, is replacing the SSN-based HICN. When the transition period ends on December 31, 2019, you must use the MBI for most transactions. 

Quality

• Upcoming Quality Payment Program Webinars this Week
• MACRA Cost Measures Post-Field Testing Webinar
• MIPS Call for Quality Measures
  
• The Deadline to Submit MIPS Year 2 (2018) Data is 1 Week Away
• Physician Quality Reporting System (PQRS) Website Retires in March 2019
  
• The March 2019 quarterly Long-term Care Hospital (LTCH) Compare refresh is available, including quality measure results based on data from the second quarter of 2017 to the first quarter of 2018.
  
• For MIPS Facility-based Eligible Providers:
• How will CMS determine if an eligible provider is facility-based? Refer to the QPP Participation Status Lookup Tool
  
• To determine if you’re facility-based, Medicare will look at your Medicare Part B claims billed between October 1, 2017 and September 30, 2018 (including a 30-day claims run out). You are considered facility-based if you are a MIPS eligible clinician type who:
• Billed at least 75 percent of your covered professional services in a hospital setting;
• Billed at least one service in an inpatient hospital or emergency room; and
• Can be attributed to a facility with a Hospital Value-based Purchasing (VBP) score
• MIPS Facility-based preview: CMS is providing a facility-based preview that allows you to see what your Quality and Cost performance category scores could look like for the 2019 MIPS performance period if you are identified as facility-based and attributed to a facility with a Fiscal Year (FY) 2020 Hospital Value-Based Purchasing (VBP) score. Sign into the QPP website or create an account to see your preview. 
• To learn more about facility-based measurement for MIPS in 2019, view the 2019 Facility-based Measurement Fact Sheet  and the Facility-based preview FAQ
• CMS has posted the following new resources to the Quality Payment Program (QPP) Resource Library: 
• 2019 Merit-Based Incentive Payment System (MIPS) Opt-In and Voluntary Reporting Policy Fact Sheet
• 2019 MIPS Promoting Interoperability Fact Sheet
• 2019 MIPS Participation and Eligibility Fact Sheet 
  
• The Deadline to Submit MIPS Year 2 (2018) Data is Less Than 1 Month Away. Data can be submitted and updated any time until 8:00 p.m. ET on Tuesday, April 2, 2019
  
• New App Designed To Help Patients Report Health Outcomes Wins Top Prize from AHRQ
• The Deadline to Submit Your Registration and Attestation Information for the Promoting Interoperability Programs is Now March 14. 

Clinical

• Effect of Interaction between Adenosine and Nitric Oxide on Central Nervous System Oxygen Toxicity.
  
• CNS function and dysfunction during exposure to hyperbaric oxygen in operational and clinical settings.
  
• Markers of Oxidant-Antioxidant Equilibrium in Patients with Sudden Sensorineural Hearing Loss Treated with Hyperbaric Oxygen Therapy. 
• Current perspectives on therapeutic ultrasound in the management of chronic wounds: a review of evidence
• AHRQ launches App for Digital Healthcare - The AHRQ Question Builder app helps patients and caregivers prepare for medical appointments and maximize visit time

Posted February 2019

Reimbursement

• Every non-exempt practitioner in the U.S. who doesn't report for MIPS soon will be penalized 5% of their Medicare reimbursements in 2020
  
• Updated Novitas Local Coverage Determination (LCD): Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041). The following CPT/HCPCS code(s) have been deleted and therefore removed from the LCD: Q4131 and Q4172. The following CPT/HCPCS code(s) have been added to Group 2 Codes: Q4186, Q4190, Q4195 and Q4196. Search by HCPCS on Product Navigator
  
• The True "Cost" of healing Most Wounds
• Medicare’s free, official “What’s covered” app delivers accurate cost and coverage information right on your mobile device 
  
• Hyperbaric Oxygen Therapy Charges About To Be Stretched On the RAC
  
• CMS Learning Network: Provider Compliance Tips for Pressure Reducing Support Services
• Guidance on Coding and Billing Date of Service on Professional Claims 

Quality

• Merit-based Incentive Payment System 2019 Changes
  
• Home Health (HH) Compare Quarterly Refresh now available, including Quality Measure "Percent of Residents or Patients with a Pressure Ulcers that Are New or Worsened (Short Stay) (NQF#0678)"
  
• Nursing Home Compare Quarterly Refresh with SNF QRP Data Now Available, including Quality Measure "Percent of Patients or Residents with Pressure Ulcers that are New or Worsened- NQF #0678"
• Join CMS for February 5 Webinar on MIPS Quality Performance Category in Year 3 (2019)
  
• Register for February 5 Webinar on the 2019 MIPS Call for Promoting Interoperability Measures and Improvement Activities
• Register for CMS’ Upcoming 101-Webinar on APMs in 2019

Clinical

• Hyperbaric oxygen therapy and mortality from carbon monoxide poisoning: A nationwide observational study. 
  
• Upcoming Technology Assessment Draft Report for Review: the Agency for Healthcare Research and Quality's (AHRQ) Technology Assessment Program will be posting a draft entitled "Skin Substitutes for Treating Chronic Wounds", and it will be available for public comment between February 13, 2019 to March 6, 2019
  
• Predictors of Diabetic Foot Reulceration beneath the Hallux. 
  
• Medical Communications and Disclosures: A Persistent Problem We Need to Fix
  
• Assessing Pressure Injury Knowledge Using the Pieper-Zulkowski Pressure Ulcer Knowledge Test.
• Glycosylated hemoglobin and hyperbaric oxygen coverage denials.
  
• Further application of hyperbaric oxygen in prostate cancer.
  
• Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019 - anticipated completion date - mid 2019
  

Posted January 2019

Reimbursement

• Summary: 2019 Medicare Physician Fee Schedule and Quality Payment Program Final Rule
  
• Proof of Delivery Documentation Requirements for items and services provided to Medicare beneficiaries. 
  
• Provider-Based Attestations - General Guidance from WPS. 
• Medicare Administrative Contractor (MAC) Palmetto GBA retired LCD and article related to skin substitutes on 1/3/2019 due to the rapidly changing nature of this category of treatments- skin substitutes vs. wound dressings.
• • Application of SKIN SUBSTITUTES (L36466) - Retired[1]
  • Billing Requirements for Application of SKIN SUBSTITUTES (Part B Services Only) (A55035) - Retired[2]

• Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019 

Clinical

• Hyperbaric Oxygen Therapy as Concurrent Treatment with Systemic Steroids for Idiopathic Sudden Sensorineural Hearing Loss: A Comparison of Three Different Steroid Treatments. 
  
• Hyperbaric Oxygen Therapy in Necrotizing Soft Tissue Infections: A Retrospective Study. 
  
• Overcoming barriers to self-management: The person-centred diabetes foot behavioural agreement. 
  
• Impact of Hyperbaric Oxygen on More Advanced Wagner Grades 3 and 4 Diabetic Foot Ulcers: Matching Therapy to Specific Wound Conditions. 
  
• Preconditioning and postoperative hyperbaric oxygen therapy to reduce skin flap erosion after osmidrosis surgery.
  

• Hyperbaric, Skin (Integument) Grafts And Flaps.

• Carbon monoxide poisoning in Denmark with focus on mortality and factors contributing to mortality.  
  
• Therapeutic effect of combined hyperbaric oxygen and radiation therapy for single brain metastasis and its influence on osteopontin and MMP-9. 
  
• Radiation-induced skin reactions: mechanism and treatment. 
  
• Delaying latency to hyperbaric oxygen-induced CNS oxygen toxicity seizures by combinations of exogenous ketone supplements. 
  
• A Case of Refractory Hemorrhagic Cystitis in which Bleeding Control was Finally Achieved by Cystectomy
• Orbitomaxillofacial Mucormycosis Requiring Complex Multifactorial Management 
• Methemoglobinemia treated with hyperbaric oxygen therapy: A case report. 
• A diver with immersion pulmonary edema and prolonged respiratory symptoms. 
• Targeting optimal time for hyperbaric oxygen therapy following carbon monoxide poisoning for prevention of delayed neuropsychiatric sequelae: A retrospective study. 

Posted December 2018

Clinical

• Hyperbaric oxygen therapy in the treatment of complications of irradiation in laryngeal cancer.
• Comparison of Two Different Treatment Protocols Using Systemic and Intratympanic Steroids with and without Hyperbaric Oxygen Therapy in Patients with Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Controlled Trial.