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HFMA recommended coronavirus resources

News | Healthcare Business Trends

HFMA recommended coronavirus resources

The list below includes links to resources HFMA’s members will find useful as they help navigate their organizations through the COVID-19 emergency. These resources include information related to Medicare, state, and commercial health plans.

These resources include links to the best currently available information related to coding, billing, coverage of services, and disaster preparedness financing during the COVID-19 national emergency

Medicare – General:

  • Expansion of The Accelerated and Advance Payments Program For Providers And Suppliers During Covid-19 Emergency:  CMS issued guidance detailing how providers can access accelerated Medicare payments, as modified by the CARES Act to provide needed liquidity during the COVID-19 pandemic. This fact sheet provides details how hospitals and physicians can access these funds and how they will be repaid.
  • Interim Final Rule in Response to COVID-19: On March 31st, CMS issued a rule that allows hospitals to increase capacity, increase the types of services that can be provided virtually, and reduce administrative burden.
  •  
  • COVID-19 National Emergency Declaration Fact Sheet: Describes in general what Medicare regulations will be waived in response to the COVID-19 national emergency declaration.
  • Provider Enrollment Simplification: Provides answers to frequently asked questions about CMS’s actions to reduce administrative barriers to enrolling additional providers in response to the COVID-19 national emergency.
  • Relief for Hospitals and Providers Participating in Quality Reporting/Payment Programs: CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. See appendix I below for specific details for each program.
  • COVID-19 Test Pricing: Provides payment amounts by MAC based on HCPCs code used.

Medicare – Telehealth Billing

  • Telehealth Provider Fact Sheet: Provides an overview of Medicare’s expanded telehealth benefit during the national emergency.
  • Telehealth Billing FAQs: Provides CMS’s answers to frequently asked questions related to billing Medicare for telehealth.
  • Telehealth Toolkit: CMS has produced a “telemedicine toolkit” with links to internet resources. Many of these links will help providers learn about the general concept of telehealth, choose telemedicine vendors, initiate a telemedicine program, monitor patients remotely, and develop documentation tools. Additionally, the information contained within each toolkit will also outline temporary virtual services that could be used to treat patients during this specific period of time.
  • Nursing Home Telehealth Toolkit: CMS has produced a “telemedicine toolkit” with links to internet resources. Many of these links will help nursing homes learn about the general concept of telehealth, choose telemedicine vendors, initiate a telemedicine program, monitor patients remotely, and develop documentation tools. Additionally, the information contained within each toolkit will also outline temporary virtual services that could be used to treat patients during this specific period of time.

State Action:

  • Medicaid FMAP Increase FAQs: CMS has released a FAQ related to the 6.2 percentage point increase in Federal Medicaid Assistance Percentage (FMAP) in the Families First Coronavirus Response Act.
  • Approved State Medicaid Waivers Related to COVID-19: Despite the national emergency, states must apply for section 1135 waivers to relax certain federal requirements in response to COVID-19.  This tool tracks which states have had waivers approved and what the waiver covers.
  • State Policy Actions Related to COVID-19: The Kaiser Family Foundation has created a resource tracking which states have eliminated cost sharing for testing and treatment related to COVID-19 for the health plans they regulate.

COVID-19 Coding:

Commercial Coverage:

Disaster Planning, Financing, and Reimbursement:

  • HFMA Disaster Planning Checklist: Provides CFOs with a checklist to help their organizations prepare for events like the COVID-19 national emergency.
  • CDC Disaster Planning Budget Tool: Currently, the industry doesn’t have clarity into how HHS will request documentation to support claims for reimbursement from the Public Health and Social Services Emergency Fund. However, it is anticipated that hospitals will be asked to accurately segregate the costs related to disaster response from normal operating costs. Keys to this will include accurate coding of pneumonia/COVID-19 cases, capture of direct costs in a discrete cost center, and documentation to support allocations of time from staff and resources that are split amongst activities. The CDC’s Disaster Budget Planning Tool is one example of a model providers could follow. While there’s no guarantee HHS will follow this model, it is a format one of their agencies has put forth as an approach.

General

Appendix I:

Provider Programs

2019 Data Submission

2020 Data Submission

Quality Payment Program – Merit-based Incentive Payment System (MIPS)

Deadline extended from March 31, 2020 to April 30, 2020.

MIPS-eligible clinicians who have not submitted any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year.

CMS is evaluating options for providing relief around participation and data submission for 2020.

Medicare Shared Savings Program Accountable Care Organizations (ACOs)

 

Hospital Programs

2019 Data Submission

2020 Data Submission

Ambulatory Surgical Center Quality Reporting Program

Deadlines for Oct. 1, 2019 – Dec. 31, 2019 (Q4) data submission optional.

If Q4 is submitted, it will be used to calculate the 2019 performance and payment (where appropriate). If data for Q4 is unable to be submitted, the 2019 performance will be calculated based on data from Jan. 1, 2019 – Sept. 30, 2019 (Q1-Q3) and available data.

CMS will not count data from Jan. 1, 2020 through June 30, 2020 (Q1-Q2) for performance or payment programs. Data does not need to be submitted to CMS for this time period.

*For the Hospital-Acquired Condition Reduction Program and the Hospital Value-Based Purchasing Program, if data from January 1, 2020 – March 31, 2020 (Q1) is submitted, it will be used for scoring in the program (where appropriate).

CrownWeb National ESRD Patient Registry and Quality Measure Reporting System

End-Stage Renal Disease (ESRD) Quality Incentive Program

Hospital-Acquired Condition Reduction Program

Hospital Inpatient Quality Reporting Program

Hospital Outpatient Quality Reporting Program

Hospital Readmissions Reduction Program

Hospital Value-Based Purchasing Program

Inpatient Psychiatric Facility Quality Reporting Program

PPS-Exempt Cancer Hospital Quality Reporting Program

Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals

 

Post-Acute Care (PAC) Programs

2019 Data Submission

2020 Data Submission

Home Health Quality Reporting Program

Deadlines for October 1, 2019 – December 31, 2019 (Q4) data submission optional.

If Q4 is submitted, it will be used to calculate the 2019 performance and payment (where appropriate).

Data from January 1, 2020 through June 30, 2020 (Q1-Q2) does not need to be submitted to CMS for purposes of complying with quality reporting program requirements.

*Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Jan. 1, 2020 through Sept. 30, 2020 (Q1-Q3) does not need to be submitted to CMS.

*For the Skilled Nursing Facility (SNF) Value-Based Purchasing Program, qualifying claims will be excluded from the claims-based SNF 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510) calculation for Q1-Q2.

Hospice Quality Reporting Program

Inpatient Rehabilitation Facility Quality Reporting Program

Long-Term Care Hospital Quality Reporting Program

Skilled Nursing Facility Quality Reporting Program

Skilled Nursing Facility Value-Based Purchasing Program

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