Month: June 2020

From MGMA Community post regarding employees and vacations during Covid times:

Denise in Colorado writes:

“Per the CDC guidelines, our office would require that the employee self-quarantine for 14 days upon return from Mexico.  The employee is likely going to be able to work from home — ie. no medical reason why they could not work.  If we require the employee to work from home, then emergency paid sick leave does not come into play, correct?  So the employee either works from home or takes another 14 days of PTO if they have it available.  That means 3-4 weeks of absence from the clinic.  

In our case we are talking about a Medical Assistant who normally takes vitals and rooms patients.  So, since working from home is generally not as productive from the company’s point of view, it seems as if the company gets caught in a double-whammy — having to find coverage for the Mexico vacation and then having to supplement coverage for the 14 days of quarantine.  I certainly want to be able to allow staff to take vacations.  However, staffing is already difficult enough without having to cover for the suggested quarantine period in addition to the vacation itself.  This seems like a pretty good deal for the staff member, and a pretty lousy deal for the company and the rest of the staff who has to cover the extended absence.  I’m not suggesting that we ignore the quarantine period.  We have to ensure the safety of all our staff.  But I’m not happy about the effect the quarantine  period has on the organization.   Thoughts?”
MGMA Associate Director, Government Affairs replies:

Thanks for posting this question. MGMA’s FFCRA employment provisions resource outlines the qualifying reasons an employee can use emergency paid sick leave under the FFCRA:

1. Employee is subject to federal, state or local quarantine or isolation order
2. Employee has been advised by healthcare provider to self-quarantine 
3. Employee is experiencing COVID-19 symptoms and seeking medical diagnosis
4. Employee is caring for individual who is subject to order described in #1 above
5. Employee is caring for his or her child if school or place of care is closed due to COVID19 precautions
6. Employee is experiencing any other substantially similar condition specified by Secretary of Labor

Per the Department of Labor temporary rules, an employee must provide his or her employer documentation in support of paid sick leave or expanded family and medical leave. Such documentation must include a signed statement containing the following information: (1) The employee’s name; (2) the date(s) for which leave is requested; (3) the COVID-19 qualifying reason for leave; and (4) a statement representing that the employee is unable to work or telework because of the COVID-19 qualifying reason. An employee must also provide additional documentation depending on the COVID-19 qualifying reason for leave. For instance, an employee requesting paid sick leave under @ 826.20(a)(1)(ii) must provide the name of the health care provider who advised him or her to self-quarantine for COVID–19 related reasons.

I highlighted (bolded) qualifying reason #2 and the related documentation required, as that would be the likely reason your employee would use for this circumstance.

As our understanding of COVID-19 continues to grow, the steps you should take to test and care for patients safely have evolved. (TMA) 6/8/2020

Check out the entire article here or click on the links below to go straight to the FAQs

• COVID-19 Testing Information Frequently Asked Questions (FAQs
• Quick How-To Testing Guide for Outpatient Clinics
• FAQ on Infection Prevention and Control for Outpatient Clinics
•  TMA’s COVID-19 Resource Center

The Department of Health and Human Services (HHS) will be distributing another $15 billion to eligible providers (Medicaid and CHIP). The deadline for this is July 20th.

To stay up on the latest information here is the link to the government website:

https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/index.html

Inpatient Medical Director for Cigna-Medicare Advantage

As most of you are aware, the number of COVID19 cases has started to increase dramatically within the last week or so.  In our routine utilization meeting, several things have come to light.

Concerning our own patients’ health, it is probably in their best interest if we try to keep them out of the emergency room.  Please make sure your patients have access to healthcare.  If the patient needs to be in the hospital, you can direct admit them from your office to the appropriate level of care and avoid the ER.

From a cost perspective, our patients are much more likely to be admitted (not observation), placed in acute long-term care, or the rehabilitation unit.  Because of emergency rules applied during the COVID19 crisis, case management has very little to do with where our patients go.  Therefore, the patients are much more likely to end up in an inappropriate level of care, regardless of the care they actually need.  This is not only potentially generating higher patient out-of-pocket costs, but is also actually costing the health plans quite a bit and will ultimately impact our bonuses.  If you can see these patients in the office, then you can refer them to SNF, direct admit(do not forget to do a prior auth.), or observation if you deem appropriate.  This will be greatly reducing the unnecessary short length of stays which are costly, possibly unnecessary, and exposing our patients to infections in the hospital.

Attached is the link to the UHC Provider News for June 2020. Topics for this Month include:

*Extending Temporary Telehealth Expansion and Reimbursement Through 9/30/20 *Extending Telehealth Cost Share Waivers *Updated COVID-19 Testing Guidance * Updated Program Dates

Attached is the link to the Cigna Medicare Advantage PCP Newsletter for June 2020. Topics this month include:

·         Social Determinants of Health (SDOH)

·         2020 Medicare Advantage Prior Auth (PA) Requirements

·         CoverMyMeds.com

·         Valuable Insights:COVID-19 Resources

·         CAHPS Corner: COVID-19 Updates

AS of July 1, 2020 the Humana Medicare Advantage PPO agreement will be effective. Packets have been emailed and mailed by US Postal.

Please be sure to review and send in your response.

Changes in National Pre-certification List (NPL)

Changes to Commercial Drug list begin October 1, 2020

Accurate Claims Processing with Aetna’s 3rd Party Claim and Code Review Prog

Follow this link to find the Update in Aetna’s InK file.