Month: January 2021
MGMA Summary for 2020 Q4
And What to Look for in 2021 Q1
On Dec. 21, Congress passed massive year-end legislation that includes $1.4 trillion in funding for the federal government in FY 2021, an additional $900 billion in COVID-19 stimulus funds, and various other provisions that impact medical groups. President Trump signed the bill into law on Dec. 27.
In the coming weeks, MGMA expects the Administration will issue guidance on certain provisions of the new law. This guidance is expected to provide more detail into how these provisions will be implemented and the impact on medical groups. As this information becomes available, MGMA will keep medical group practices updated and will be revising resources, such as those published in MGMA’s COVID-19 Recovery Center.
Key provisions of the law include the following:
Medicare payment
- Increases Medicare payments across the board for CY 2021 from what was finalized in the 2021 Physician Fee Schedule (PFS) by adding $3 billion into the PFS and delaying payment of HCPCS add-on code G2211 for three years. MGMA expects that the Centers for Medicare & Medicaid Services (CMS) will release information regarding the updated payments for 2021 once it factors in the 3.75% increase to the PFS and calculates the impact of delaying G2211. We expect CMS to communicate the new conversion factor and new payment rates to local Medicare Administrative Contractors, who will update their schedules accordingly. These payment increases follow significant MGMA advocacy and will serve to offset cuts previously slated for Jan. 1, 2021.
- Temporarily suspends the 2% Medicare sequester from Jan. 1 through March 31, 2021. MGMA advocated for an extension of the current moratorium on Medicare sequestration authorized in the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
- Extends the work geographic index floor under the Medicare program through Dec. 31, 2023.
- Expands access to mental health services furnished through telehealth past the expiration of the COVID-19 public health emergency. MGMA expects to see further guidance from CMS on this policy change.
Paycheck Protection Program (PPP)
- Extends and modifies the PPP to provide further flexibilities, such as:
- A simplified loan forgiveness application process for loans under $150,000;
- Clarification that loan recipients may deduct forgiven PPP loans;
- The creation of a “PPP second draw” loan for businesses that meet certain criteria;
- The allowance of additional eligible and forgivable covered expenses;
- The ability for certain 501(c)(6) organizations to qualify for a PPP loan; and
- The ability to elect a covered period ending between 8 and 24 weeks after loan origination.
- MGMA expects the U.S. Department of the Treasury to issue and update guidance to reflect the modifications made to the PPP in the coming days.
Provider Relief Fund (PRF)
- Adds $3 billion to the $175 billion PRF and clarifies how recipients can use funds to cover “lost revenue” attributable to COVID-19. The new law allows providers to calculate lost revenues using a budgeted-to-actual revenue comparison, rather than actual year-over-year comparisons as currently required by Department of Health & Human Services (HHS) guidance.
- This change, as well as the addition of funds, is welcome news; however, it remains to be seen how HHS will implement new clarification. Group practices should continue to monitor the PRF website for updates based on the new legislation in the coming days or weeks.
FFCRA paid sick and family leave
- Extends the refundable payroll tax credits for paid sick and family leave enacted in the Families First Coronavirus Reponses Act (FFCRA) through March 31, 2021, so employers may choose to continue offering paid leave to their employees. It does not, however, require employers to extend FFCRA paid sick and family leave past Dec. 31, 2020.
Surprise billing
- Provides patient protections from out-of-network medical bills. Nonparticipating providers at emergency facilities (or a participating provider at a nonparticipating emergency facility) will not be permitted to bill a patient beyond the allowed cost-sharing amount. Instead, the patient’s health plan will make an initial payment directly to the provider or issue a notice of denial. If the provider or plan is not satisfied with the payment, either party may initiate an Independent Dispute Resolution (IDR) process, which is overseen by a third party entity who has no affiliation with the provider or payer. Each party then submits a payment offer for consideration by the IDR entity, who selects one prevailing offer as the final payment amount.
- This provision is set to go into effect in 2022 and will involve rulemaking from the Administration to provide certain implementation details. Following MGMA advocacy, at the last minute lawmakers included improvements to the IDR process.
Alternative Payment Models (APMs)
- Freezes the 2020 qualifying participant thresholds required to achieve APM benefits, such as the 5% lump sum bonus. These thresholds were set to increase in 2021 to unrealistic levels, however pursuant to this legislation, will remain at the 2020 thresholds (at least 50% of Medicare Part B payments or at least 35% of Medicare patients through an advanced APM entity) through 2023. MGMA strongly supported maintaining 2020 thresholds in 2021 and beyond to allow more group practices to realize the benefits of APM participation.
BCBSTX AND CHI UPDATE
POET has received an update from BCBSTX regarding CHI.
“CHI is not going out of network. Your providers that only have CHI for hospital privileges will be good.”
HSConnect
If you are experiencing an issue with HSConnect, Please Read.
From HealthSpring regarding referrals: Our apologies for the inconvenience and confusion, but this is a known issue within the HSConnect/MHK platform. All of our specialists are showing non-participating in HSC/MHK as of 2021 for some reason, even with a correct NPI of a participating specialist. It is currently being researched and examined on this end. In the meantime, my understanding is that the PCP can still submit the referral despite the notification – it’s just causing some confusion to see a par provider listed as non-par. We’re hoping to rectify the issue as soon as possible as to limit the disruption for our physician offices and members.
If you are having an issue checking eligibility, you may do so via automated phone system:
1-800-230-6138, option 1
To request HSConnect support (Please take screen shots if possible) Email:[email protected]
UHC Claim Reconsideration, Appeals Process 1/1/2021
2021 UnitedHealthcare Administrative Guide
“You must submit both your reconsideration and appeal to us within 12 months (or as required by law or your Agreement), from the date of the EOB or PRA. The 2-step process, as outlined below, allows for a total of 12 months for timely submission for both steps (Step 1: Reconsideration and Step 2: Appeals).”
To view the full Claim Reconsideration and Appeal process, forms, instructions, and etc. for UHC follow this LINK.
Texas Health Plans Adopt Various Temporary Deadlines for CoVid-19
The Texas Medical Association has been tracking health plans’ various waivers throughout the COVID-19 pandemic, as well as state and federal deadlines and program extensions.
Find more information, tools, and resources check out the full article. Located in InK file, “The Business End” or just click on the highlighted text.
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