Optimizing Advanced Practice Providers
MGMA, October 2020
The COVID-19 pandemic has amplified the previously growing importance of advanced practice providers (APPs) in care delivery and practice performance.
Increasing demands for healthcare point to a projected physician shortage, estimated to reach between 54,100 and 139,000 physicians by 2033.1 One strategy to address this shortage is to close gaps in primary care access through increased use of APPs. One estimate points to expanded use of nurse practitioners (NPs) could reduce primary care physician (PCP) shortages by 70%.2
Many practices already recognize the substantial boost that APPs can provide to practice performance, with APP utilization growing. MGMA data show that almost 67% of Better Performer practices employ APPs; for physician-owned practices, that rate jumps to
almost 87%.3
Cigna Online Appeals and Claim Reconsideration 11/9/2020
Now you can submit appeals and claim reconsideration requests online for medical claims using the Cigna for Health Care Professionals website (CignaforHCP.com). This is an enhancement you’ve been asking for and we’ve been working hard to provide you with an easy-to-use tool
Ransomware Threat Targeting HealthCare Providers. 11/09/2020
You can’t afford to continue to look the other way.
SOME GREAT TIPS TO SHARE WITH YOUR STAFF.
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/11/Ransomware-Threat-Targeting-Health-Care-11062020.pdf” download=”all” viewer=”google”]HEIGHTENED RANSOMWARE THREAT: ACTION STEPS
MGMA members-the federal government has announced a heightened risk of malware/ransomware attacks on the healthcare industry-including physician practices and inpatient facilities. We wanted to identify some actions you can take to reduce your risk and resources to assist you.
Actions to reduce your risk:
- Discuss the issue of cybersecurity with your IT/website vendor and have them block known sites that provide known functionality to the malware (reference the IOC list below)
- Have your IT/website vendor monitor endpoint detection on servers and workstations for changes in applications and running services
- Have your IT/website vendor monitor all new account creations. Especially critical are those with administrator access
- Have your IT/website vendor confirm that your data backup systems are in place and working effectively. Remember that offsite data storage is preferable
- Ensure your practice’s business continuity and disaster recovery plans are up-to-date and readily available
- Discuss the heightened threat with your administrative and clinical staff and the increased need to stay highly diligent during this time
- Consider instituting a practice-wide policy prohibiting staff use of personal email accounts as a method to decrease your risk
- Remind staff not to open emails and/or attachments from unknown senders (and even be cautious with attachments from recognized senders)
- Encourage staff to inform you regarding any suspicious email or cyber incident
Resources:
HHS Bulletin: us-cert.cisa.gov/sites/default/files/publications/…
IOC List: gist.github.com/aaronst/…
MGMA member-benefit Cybersecurity Action Steps
Robert Tennant MA
Director of Health Information Technology Policy MGMA Government Affairs
Washington DC
REPAYMENT OF ADVANCE PAYMENTS
QUESTION: We have received letters indicating when repayment of Advanced Payments will begin. Has Medicare released anything on exactly how that will work and how the remit will look? Will there be specific CARC or RARC codes used? Thanks!
MGMA REPLY:
Thanks for posting this question! Earlier this month, CMS announced the details of Medicare Accelerated & Advance Payment (AAP) recoupment, which are consistent with legislation passed by Congress in September:
“Providers were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.”
Regarding remits, CMS indicates in its AAP FAQ, “Providers and suppliers will see the offset amount reflected on their Remittance Advice. Providers and suppliers should contact their MAC to receive current balance and payment information related to the repayment of their AAP payment.” I have not yet seen specifics around which codes will be used on the remits. However, the Agency plans to issue further information on the recoupment process at a later date, and the details of these adjustment codes may be covered in future guidance.
Please let me know if I can provide any further clarification!
Best,
——————————
Matt Devino
Associate Director, Government Affairs MGMA
Washington DC
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Are You Confused About Out-of-Network Reimbursements?
Do you want to know more about 3rd-Party Agreements, What is an assigned benefit, What is a Limited Benefit Plan? Then this is the article for you.
Information from Collect Rx
HSConnect Integration Issue, Cigna HealthSpring?
Here is the Help Desk Information
(866) 952-7596
When emailing, please send print screens of the error or problem.
Assisting the Elderly with Virtual Visit, How to Bill.
If your office assist a patient that does not have the technology to complete a virtual visit with another physician, while the patient is having an in patient visit at your office, can you bill?
Cigna’s response to COVID-19
Cigna Coronavirus (COVID-19) Interim Billing Guidance for Providers for Commercial Customers. Updated October 30, 2020 – Highlighted text indicates updates.
As the COVID-19 pandemic continues, we appreciate that providers across the country are on the front line to offer dedicated care to our customers and help protect local communities.
As federal guidelines continue to evolve in support of the COVID-19 pandemic, we have again extended our interim coverage accommodations for commercial Cigna medical services, as follows:
- The cost-share waiver for COVID-19 diagnostic testing and related office visits is extended until January 21, 2021.
- The cost-share waiver for COVID-19 related treatment is extended until December 31, 2020.
- Some other interim accommodations (e.g., for credentialing and authorizations) are extended through December 31, 2020, as outlined on this page.
- The interim COVID-19 virtual care guidelines as outlined on this page are in place until December 31, 2020. Beginning January 1, 2021, we will implement a new Virtual Care Reimbursement Policy. Please visit CignaforHCP.com/virtualcare for additional information about this new policy.
Emailing Archiving and Hippa Compliance
Make Sure email is a part of your cybersecurity stategy.
Email archiving is an automated process for preserving and protecting all inbound and outbound email messages (as well as attachments and metadata) so they can be accessed later. In other words, email archiving is storing emails and making them searchable.
Email archiving providers take this burden off organizations by storing emails on their servers while making them accessible to designated administrators in the organization. This is different than simply creating an email data backup. Data backups do not allow searching, so if a particular email needs to be found, it might take weeks for you to find it
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