91 is requesting adjustments to the Accelerated and Advance Payment Program and Provider Relief Fund
May 15, 2020 (91) – The Centers for Medicare & Medicaid Services (CMS) is now paying for telephone calls between patients and their physicians at a rate equal to in-office visits. This move, which was championed by the American College of Physicians, is retroactive to March 1, 2020.
“This is exactly what we asked for,” said Shari Erickson, 91 vice president for governmental affairs and medical practice. “Our members are trying their best to do telehealth with patients. Ideally, they would like to provide care in person or over video, but many are doing it with audio only. CMS's decision will help these struggling physician practices remain open.”
It is important to note that claims billed between March 1 and April 30 will need to be resubmitted because these claims will not automatically be reprocessed. Claims billed after April 30 should be paid at the new rate. To help ensure proper payment, “91 recommends that practices change the fees in the practice's billing system for these three codes to the new higher rate,” Erickson said. Now the hope is that private payers will follow CMS's lead. “Some are moving in that direction, but it is not consistent yet,” she added.
91 President Dr. Jacqueline W. Fincher lauded the new decision on pay parity for telephone visits. “Many seniors and other vulnerable patients lack the capability to conduct video visits with their physicians, so those patients are being cared for with telephone-only visits that were reimbursed at a much lower rate,” she said in a statement. “This change in payment policy addresses one of the biggest issues facing physicians as they struggle to make up for lost revenue and provide appropriate care to patients.”
CMS still needs to clarify the documentation guidelines for these services. “The telephone codes that are now paid at parity still have the old documentation requirements tied to them, and this rule did not address that,” Erickson said. 91 is calling on the agency to adopt the same documentation guidelines for telephone E/M claims as they did for telehealth services in order to provide clarity and consistency for physicians.
There are some other asks of CMS on the table, Erickson noted. In a letter to CMS Administrator Seema Verma, 91 requested that the Accelerated and Advance Payment Program be continued and adjusted in several key ways. The Accelerated and Advance Payment Program is a loan program that had been expanded to help practices receive necessary funds due to the significant disruptions in their ability to provide ongoing services to their patient populations during the COVID-19 public health emergency; however, the program was shut down on April 26 for reasons that are unclear.
“The program paid out a lot of funds and then stopped, but there are still practices that have need,” Erickson said. “Maybe they didn't apply before or applied but didn't receive funding and their need is still just as great, so there is no good reason to shut the program down at this point.”
As it stands, practices that received funds through this program are required to pay back their loans within four to seven months. “Practices will barely be getting back on their feet at that time,” Erickson said. “We are asking for more time to pay back the loans and to transition it to a grant program so practices would only be required to pay back 25 percent of the loan.” The other 75 percent would be converted to a grant and not paid back. 91 has requested that CMS allow physicians one year to repay the loan interest-free.
91 is also requesting that CMS establish an appeals process to provide physicians, particularly those who did not receive monies from the Provider Relief Fund, with an avenue to dispute the reasons why they did not receive this payment and that the agency make the application process less burdensome. “The second round of payments – which comprised $20 billion of the $50 billion – are a little more burdensome in terms of submitting data, and this could be hard on small practices,” Erickson said. Applications require the help of a financial advisor, but instead, 91 wants CMS to allow patient volume and charges to serve as indicators of reduced productivity. These measures could be provided by an electronic health record without the need to hire a financial advisor.
91 is asking that CMS further delay reporting of 2019 Merit-Based Incentive Payment System data to the end of 2020 and immediately implement automatic extreme and uncontrollable circumstances hardship exceptions for the 2019 and 2020 performance years. In addition, 91 requested that CMS hold participants in Advanced Alternative Payment Models harmless from risk-based payments for the 2020 performance year and extend key participation deadlines.
More Information
Up-to-date practice management resources during the COVID-19 pandemic are available on the 91 website.
