Posted March 2023

Clinical

• AHRQ Systematic Review on telehealth: Use of Telehealth During the COVID-19 Era Systematic Review Jan 3, 2023 concluded that: "Whereas telehealth use spiked after the beginning of the pandemic, the characteristics of patients using telehealth follow a pattern similar to that for other healthcare and digital health services. We found that the use of telehealth may be comparable to in-person care across different clinical and process outcomes. Telehealth implementation has addressed the needs of both patients and providers to some extent, even as clinical conditions, patient and provider characteristics, and type of assessment varied. Telehealth has provided a viable alternative mode of care delivery during the pandemic and holds promise for the future."
• AHRQ Systematic Review on telehealth: Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication Systematic Review Dec 26, 2022: concluded that "While the evidence base is limited, what is available suggests that telehealth supporting provider-to-provider communications and collaboration may be beneficial. Telehealth studies report better patient outcomes in some clinical scenarios (e.g., outpatient care for depression or diabetes, education/mentoring) where telehealth interventions increase access to expertise and high-quality care. In other applications (e.g., inpatient care, emergency care), telehealth results in patient outcomes that are similar to usual care, which may be interpreted as a benefit when the purpose of telehealth is to make equivalent services available locally to rural residents. Most barriers to implementation are common to practice change efforts. Methodological weaknesses stem from weaker study designs, such as before-after studies, and small numbers of participants. The rapid increase in the use of telehealth in response to the Coronavirus disease 2019 (COVID-19) pandemic is likely to produce more data and offer opportunities for more rigorous studies."
  

Posted February 2023

Reimbursement

Home Health

• Expanded Home Health Value-Based Purchasing Model in effect in CY2023: see overview, list of quality measures. 
• Home Health: The next Home Health, Hospice & DME Open Door Forum is scheduled for Thursday, February 23, 2023 PM at 2:00 PM-3:00 PM Eastern Time (ET)
• Medicare Home Health Prospective Payment System CY 2023 Webinar - March 29
• Expanded Home Health Value-Based Purchasing Model: First Performance Year Quick Guide Materials
• Home Health: Revised Editing of Telehealth Claims

Skilled Nursing Facility

• SAVE THE DATE: National Nursing Home Stakeholder Call on Feb. 22, 2023
• HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing: April 2023 Update

Compliance

• What’s the Comprehensive Error Rate Testing Program?

Clinical

• Clinical and biochemical short-term effects of hyperbaric oxygen therapy on SARS-Cov-2+ hospitalized patients with hypoxemic respiratory failure. atients underwent HBOT improved O2 Sat with lower levels of severity markers (WC and platelets count, D dimer, LDH, SAA). Moreover, HBOT reduced proinflammatory agents (sVCAM, sPselectin, TNFα) and increased anti-inflammatory and pro-angiogenic ones (IL-1RA and VEGF).
  
• Utilization of a topical autologous blood clot for treatment of pressure ulcers: The topical autologous blood clot therapy (TABCT) is a point-of-care treatment used as a blood clot to assist in recreating and repairing the extracellular matrix (ECM). TABCT exhibited efficacy in percentage area reduction of PUs. In addition, TABCT use prompted granulation tissue formation over vital structures, such as bone, which is often present in later stage PUs.

Posted January 2023

Reimbursement

2023 Medicare Physician Fee Schedule

 As published on the "CMS Fact Sheet":

• Payment rates and conversion factor: the finalized CY 2023 Medicare conversion factor (CF) is $33.06, a decrease of $1.55 or 4.5 percent from the 2022 CF of $34.61. The decrease is largely a result of an expiring three percent increase funded by Congress through 2022. The additional approximate 1.6 percent decrease is the result of budget neutrality requirements that stem from the revised E/M changes. The AMA and the Federation are strongly advocating that Congress avert this payment cut. For CMS physician fees associated with common procedures in wound care, see printable WoundReference tool in "HCPCS/CPT Codes and Physician Fee Schedule Commonly Utilized in Wound Care and HBOT".
• Evaluation and Management (E/M) Visits: Similar to the approach CMS finalized in the CY 2021 PFS final rule for office/outpatient E/M visit coding and documentation, CMS finalized and adopted most of these AMA CPT changes in coding and documentation for Other E/M visits (which include hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment) effective January 1, 2023. This revised coding and documentation framework includes CPT code definition changes (revisions to the Other E/M code descriptors), including:
• New descriptor times (where relevant).
• Revised interpretive guidelines for levels of medical decision making.
• Choice of medical decision making or time to select code level (except for a few families like emergency department visits and cognitive impairment assessment, which are not timed services).
• Eliminated use of history and exam to determine code level (instead there would be a requirement for a medically appropriate history and exam).
• Skin substitutes: see blog post "Skin Substitutes - What's New in 2023? Are Major Updates Coming Up?" 
• Split (or Shared) E/M Visits: for CY2023, clinicians who furnish split (or shared) visits will continue to have a choice of history, or physical exam, or medical decision making, or more than half of the total practitioner time spent to define the “substantive portion” instead of using total time to determine the substantive portion, until CY 2024. This policy determines which professional should bill for a shared visit by defining the “substantive portion,” of the service as more than half of the total time. 
• Telehealth: CMS is extending telehealth coverage for an additional five months beyond the end of the public health emergency (PHE) for the codes that were only going to be on the telehealth list through the end of the PHE. CMS agreed to maintain the same payment rates for office visits provided in-person or via telehealth through the end of 2023 instead of reducing payments for telehealth visits to the facility rates. As of January 2023, the U.S. has renewed the Covid public health emergency every 90 days since January 2020. Physicians and practitioners may continue to bill with the place of service (POS) indicator that would have been reported had the service been furnished in-person.  These claims require the modifier “95” to identify them as services furnished as telehealth services. 

2023 Hospital Outpatient PPS

As published on the Federal Register:

• OPPS payment rates: 
• In general, OPPS payment for wound care procedures decreased. The largest decrease was for application of high-cost skin substitute (by 9.5%). However, some procedures had their payments increased, including: application of low cost skin substitute, punch and incisional biopsy, subcutaneous tissue, muscle and bone debridement, negative pressure wound therapy, hyperbaric oxygen therapy, incision and drainage, non-invasive vascular study. See "CMS' Hospital Outpatient Regulations and Notices" and WoundReference tool "Chargemaster Template for Hospital Outpatient Wound Care Services"
• Skin substitutes:
• CMS did not finalize its proposal to change the terminology or payment of skin substitutes for CY 2023 (see blog post "Skin Substitutes -  What's New in 2023? Are Major Updates Coming Up?"). For CY 2023, CTPs will continue to be divided into a high-cost or low-cost group. For details on CMS' high-cost or low-cost classification, see section 'Coding, Coverage and Reimbursement' in WoundReference topic "Cellular and/or Tissue-Based Products".
• HCPCS codes:
• HCPCS “A” codes (supply codes): since January 2022, all new skin substitute products with an FDA 510(k) clearance have been receiving  product-specific A-codes in the HCPCS A2XXX series (87 FR 44655). These products include both biological products that are not human cell, tissue, or cellular or tissue-based products (HCT/Ps) as well as synthetic products. Previously used exclusively in the physician office setting, in April 2022, CMS made all HCPCS A2XXX series codes payable under the OPPS. 
• HCPCS code C1849: for a while providers under the OPPS could use either HCPCS C1849 or product-specific A-codes in the HCPCS A2XXX series to report the usage of synthetic skin substitute products. However, for CY2023 CMS finalized its policy to eliminate HCPCS code C1849 and eliminate redundancy. That is, effective January 2023, providers should use product-specific HCPCS codes in the HCPCS A2XXX series for synthetic skin substitute products that were previously described by HCPCS code C1849. Also, any synthetic skin substitute product that is currently described by HCPCS code C1849, would have been described by HCPCS code C1849, or is assigned a code in the HCPCS A2XXX series will be assigned to the high-cost skin substitute group, even if cost and pricing data are not available for any individual product. 
• OPPS Transitional Pass-through (TPT) Payment for Drugs, Biologicals, and Devices: a pass-through status temporarily provides payment for the new product while collecting data to support the establishment of a permanent payment mechanism at the end of the 2-3-year transitional period. Devices that are eligible for TPT status demonstrate substantial clinical improvement, are new and meet specific cost criteria.
• For CY 2023, 1 (one) wound care relevant device type continues to qualify for transitional device pass-through status: autograft suspension, including cell processing and application, and all system components (HCPCS code C1832, examples include Recell). 
• Transitional Pass-through payments are made to hospital outpatient facilities or ambulatory surgical centers (ASC). Effective January 1, 2022, the complete list of pass-through payment device category codes can be found in the CMS Internet Only Manual (IOM), Chapter 4, Section 60.4 of the Medicare Claim Processing Manual (PDF).

Quality

• For a fact sheet on the CMS CY 2023 Quality Payment Program changes, please visit this link (clicking link downloads zip file)
  

News and Articles posted before January 2023

For News and Articles posted before January 2023, see blog post "Recent News and Articles - Hyperbaric Oxygen Therapy and Wound Care (2018-2022)"