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May 15, 2020

Posted May 2020

Compliance - HIPAA

Reimbursement

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

Reimbursement

Clinical

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

Clinical

Safety

Posted February 2020

Reimbursement

Quality

Clinical

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 RevisedOn 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

Posted December 2019

Reimbursement

Clinical

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 ServicesCMS 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

Posted October 2019

Reimbursement

Quality

Clinical

Posted September 2019

Reimbursement

Quality

Clinical

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.

Quality

Clinical

    Posted July 2019

    Reimbursement

    Quality

    Clinical

    Posted June 2019

    Reimbursement

    Quality

    Clinical

    Posted May 2019

    Reimbursement

    Quality

    Clinical

    Posted April 2019

    Reimbursement

    Quality

    Clinical

    Posted March 2019

    Reimbursement

    Quality

    Clinical

    Posted February 2019

    Reimbursement

    Quality

    Clinical

    Posted January 2019

    Reimbursement

        Clinical

        Posted December 2018

          Clinical

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