POET Is Seeing a Trend
Please contact POET if you are experiencing a similar problem. (936) 637-7638
POET has received a few calls this week from Specialists (SCP) stating that Primary Care Physicians (PCP) have not been able to get the SCP a referral. The PCP office is stating Cigna MA is showing the SCP out of network.
- POET has been in contact with Cigna MA regarding the situation. Cigna will be reviewing to see if there is a greater problem.
- So far it appears to only be effecting SCPs in the HMO product.
- Just a reminder: SCPs do not need a referral due to the Public Health Emergency (PHE). The PHE is scheduled to lapse on January 16, 2022. POET has been on the Public Health Emergency website and the U.S. Department of Health & Human Services website to look for new information on the PHE lapse date. We have nothing to report as of this post.
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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.
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