Month: December 2021
Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes
- No payment adjustment through March 31, 2022
- 1% payment adjustment April 1 – June 30, 2022
- 2% payment adjustment beginning July 1, 2022
POET Apology
POET had some issues with the Ink site last week. Hopefully they have all been resolved.
Question Posed Regarding New POS 10
One Person Reaches out to MGMA for Advice:
“I need confirmation regarding the new POS 10. The new POS code 10 and the revision to POS code 02 goes into effect on April 4, 2022 (Medicare), and January 1, 2022, respectively. After the effective date, POS code 10 will be used if a patient receives telehealth at home, and POS code 02 will only be used for the other eligible originating sites (in other words, other places besides a patient’s home where a patient may be located and receive telehealth services that may be reimbursed by Medicare).
It is my understanding that the POS 10 would only be used for mental health/substance abuse telehealth services as they are the only services that will be covered if provided at home.
Should practices continue to use POS 02 until the PHE officially ends or should they begin using POS 10 (January 1, 2022 for all payers except for Medicare) and April 4, 2022 for Medicare? “
Claire Ernst J.D., Government Affairs Director MGMA, Washington DC. Responds:
“Thank you for your question. When I saw CMS’ notice about the revised POS codes in October, I had the same question. My assumption is that POS 10 should be used for the new mental health telehealth services, but most likely once the COVID-19 PHE ends. The mental telehealth expansion provided in the Consolidated Appropriations Act, 2021 (CAA) and subsequently codified in the 2022 final Medicare Physician Fee Schedule (PFS) allows for mental health services to be rendered to patients in their homes (with some conditions). Although this was covered in the 2022 PFS, the mental telehealth expansion provision in the CAA was meant to allow for providers to continue treating patients for mental health conditions from the home following the conclusion of the PHE. Practitioners can continue providing care to patients in their homes through the end of the PHE and will be reimbursed at the in-person rate if the 95 modifier is used.
I reached out to the staff at CMS to confirm, but have not heard back yet. I will follow up with them again and provide any feedback in this thread”
CoVid Vaccine Mandate, Update
ADVOCACY RESOURCE – DECEMBER 2, 2021
Claire Ernst J.D.
Government Affairs Director MGMA
Washington DC
MGMA Legislative Alert
POSTED 12/9/2021 6:51 PM
Aetna, No Longer Paying Office Consult
*ALERT*
Starting March 1, 2022, Aetna will no longer pay office consultation codes 99241 – 99245
*ALERT*
You have to revalidate your enrollment to stay in Medicaid.
If you are a physician participating in the Texas Medicaid program and saw your required revalidation period for the program extended due to the COVID-19 pandemic, take note:
The End Of That Extension Is Coming on February 28th, 2022.
MGMA, Update on the Court Cases Involving CoVid-19 Vaccination Mandates.
Per Claire Ernst J.D., Government Affairs Director MGMA
“I wanted to provide a quick update on the court cases involving the COVID-19 vaccination mandates. As many of you have seen, both the OSHA vaccination and testing emergency temporary standard (ETS) and the CMS facilities vaccination mandate were quickly challenged in court. Below is a quick overview of where the mandates currently stand – this is subject to change:
- OSHA vaccination and testing ETS: On Nov. 12, 2021, the U.S. Circuit Court of Appeals for the Fifth Circuit granted a motion to stay (or halt) the ETS. After that decision, OSHA suspended enforcement pending future developments in the litigation. More information about OSHA’s announcement can be found on the ETS landing page. The U.S. Court of Appeals for the Sixth Circuit now has jurisdiction over the challenges and will issue its decision. However, it is certainly possible that following the Court’s ruling, the decision could get appealed to the U.S. Supreme Court.
- CMS facilities vaccination mandate: On Nov. 30, 2021, the U.S. District Court for the Western District of Louisiana issued a preliminary injunction halting the mandate. The ruling comes one day after the U.S. District Court for the Eastern District of Missouri halted implementation of the rule for 10 states. Together, the decisions apply to all states. However, this decision is likely to get appealed as well.
MGMA will continue to monitor this evolving situation and provide updates.”
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