HSConnect Headache??
THERE IS RELIEF INSIGHT!!
To align with the recent extension of the federal public health emergency (PHE) period, Cigna is again extending the cost-share waiver for COVID-19 testing and testing-related services through April 20, 2021.
- Referrals requirements for in-network providers & out-of-network providers are waived through 04/20/2021.
- Providers do not have to go into HSConnect/MHK for referrals, but they will need to continue doing pre-certs for any services that require them.
- Specialists should accept members without a referral during this time. Referral requirements for in-network providers & out-of-network provider are waived through 04/20/2021.
For the most up to date information please go to https://medicareproviders.cigna.com/
Eliminating Staff Gossip
Here are some tips to make your office a gossip-free zone.
Creating a winning team culture in an office is a key to success that cannot be overlooked. Most team builders come in with a lot of buzzwords, flashing lights, and games in order to engage staff members; often times their solutions dwindle and fade as fast as they arrived. There are simple solutions that create a unified team environment that can become permanent. One of the easiest ways to build team unity is a no gossip policy.
The policy is simple- gossip once and you will be warned, gossip again and you will be released. You could implement a few different versions, and with a problematic and bickering staff, you may have to add a few additional steps prior to releasing an employee.
Gossip is dishonest, contagious, and breeds disloyalty for your medical practice and within your team. All of the standard bullet points about building a great culture within your company are affected by gossip. Typically, team members that gossip about each other, gossip about everybody: staff, physicians, patients, and business. It is not “healthy” for your office to allow gossip and having an office full of gossip is a quick way to experience legal and professional ramifications.
When you bring a policy like this into an existing office dynamic, it is imperative that you don’t hand this out in a memo or e-mail. It is imperative to hold a team meeting, with a detailed explanation, and an opportunity for your team to ask questions.
This policy may not be well-received by all of your staff or team members at first. Your biggest culprits will be the most vocal and try to win over the others. Quality people do not gossip, and after the initial implementation phase of this policy, you will be left with quality people, who monitor and remind each other to remain gossip free.
To read the article on the web. https://www.physicianspractice.com/view/eliminating-staff-gossip-at-your-practice
Cigna Offices Closed 1/18/2021 for MLK day.
This includes HealthSpring.
CMS has confirmed that the new 2021 conversion factor
To follow up with more information from the recent legislation which added $3 billion to the Physician Fee Schedule and delayed implementation of G2211 (add-on complexity code), CMS has confirmed that the new 2021 conversion factor will be $34.8931 instead of $32.4085. CMS also updated the 2021 RVU file.
We expect to see a formal announcement regarding these developments in the near future.
We also expect CMS to communicate the new conversion factor and payment rates to local Medicare Administrative Contractors (MACs), who will update their schedules accordingly. For accurate rates based on your geographic area, we recommend checking with your local MAC.
MGMA Government Affairs would like to invite all of you to the next session of our GovChat Live series
Happy New Year! Given that 2021 is finally upon us, MGMA Government Affairs would like to invite all of you to the next session of our GovChat Live series to discuss the latest issues we are following in the new Congress and incoming administration.
We will focus on the government funding and emergency COVID-19 relief package that was signed into law late last month that made changes to several programs including Medicare payment, the Provider Relief Fund, the Paycheck Protection Program, and also introduced new rules around surprise billing. We will also discuss the issues on our radar with the incoming Biden Administration and how we will approach advocacy this year.
When: Jan 14, 2021 02:00 PM Eastern Time
Topic: GovChat Live: COVID-19 Relief Package & Advocacy in 2021
Register in advance for this webinar: mgma.zoom.us/webinar/register/WN_6w-BBIZsRcubBwe7TXPFOQ
After registering, you will receive a confirmation email containing information about joining the webinar.
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.”
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