It's not too late to become a Solutions Summit sponsor! Please reach out to Joanne Tanner at [email protected] .

New Member Spotlight: Mission Physician Partners 

Mission Physician Partners provides customized services designed to enable both hospitals and physician practices to be the pride of their community. Mission brings together multiple stakeholders to create excellence in the emergency room, inpatient departments, outpatient specialty practices, and telehealth areas. Their services are specialized for their clients and range from best practices for physician practices, ED workflow planning, Hospital and Physician consulting, billing, coding analysis, strategic planning, recruitment, and much more. If you are interested in learning more about Mission Physician Partners, please click here.

Excerpts from a conversation with Brant Gamble, MBA, CEO and Co-Founder, and Michele Sexton, Chief Strategy Officer, and Co-Founder

Mr. Gamble and Mrs. Sexton have worked together for many years in large physician groups and seen first-hand that there are many opportunities to improve back-office operations, billing practices, and other areas. Thus, in 2018 they formed Mission Physician Partners. Their clients range from small to large independent physician practices as well as hospitals. They offer individualized, customized plans to meet their client's needs - from operational improvements to billing and coding analysis, strategic planning, recruitment, overall financial assessment, patient satisfaction training, and throughput analysis. With one of their clients, through a coding analysis, they quickly identified an issue where the insurance company had not paid a certain code appropriately. This was corrected and Mission ensured the practice was appropriately paid. Another area of success has been working with small groups looking to grow their practices and improve operations while also keeping their independence, local ownership, and control. Mission Physician Partners has been critical in a few mergers that resulted in several physician groups coming together and meeting these important objectives-thereby getting stronger and more capable in meeting their clinical, business, and financial goals..

In building their company, Brant said that he wanted to ensure that he had a diverse team, including compliance experience, credentialing, core management capabilities, billing and coding experts, and more. Brant and Michele understand that some teams see changes as an intrusion but they know "what has been good enough to get you here is not good enough to keep you here" and know that teams who recognize this realize that they have an opportunity to get better and keep learning.

The Mission Physician Partners team includes many seasoned healthcare veterans. One of the main goals of the organization is to help hospitals partner with physicians. Mission supports local leadership and improving processes and relations within the healthcare community. Mission helps bring together physicians and hospitals in a relationship that is productive and forward-thinking.

Ms. Sexton explained that both she and Brant were familiar with EDPMA and its focus on business best practices and advocacy successes, particularly on reimbursement issues, from years of working in emergency medicine physician groups.

They have found, along with their clients, that so much is changing in emergency medicine, and the learning curve is short. Mission Physician Partners recognizes that EDPMA's advocacy activities, information, and action alerts-all available through their membership, enable their team to stay aware of the latest issues in emergency medicine, to keep their clients up-to-date and to take action when opportunities arise. Plus, Brant highlighted the importance of the networking opportunities available at EDPMA's Solutions Summit conference (May 3-6, Nashville). 

Welcome New Members! 

 

EDPMA would like to welcome three new members this month: 

Dumas Law, PLLC, Houston, TX
Hospital Physician Advisors LLC, Cary, NC
International Board of Credentialing and Continuing Education Standards (IBCCES), Jacksonville, FL

We look forward to working with you!

Special Edition - Friday, March 6, 2020

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

CMS Develops Additional Code for Coronavirus Lab Tests 

Agency Issues Fact Sheets Detailing Coverage under Programs
On March 6, CMS took additional actions to ensure America's patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).

CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children's Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well.

"CMS continues to leverage every tool at our disposal in responding to COVID-19," said CMS Administrator Seema Verma. "Our new code will help encourage doctors and laboratories to use these essential tests for patients who need them. At the same time, we are providing critical information to our 130 million beneficiaries, many of whom are understandably wondering what will be covered when it comes to this virus. CMS will continue to devote every available resource to this effort, as we cooperate with other government agencies to keep the American people safe."

HCPCS is a standardized coding system that Medicare and other health insurers use to submit claims for services provided to patients. Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. CMS expects that having specific codes for these tests will encourage testing and improve tracking.

The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020. Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them. As with other laboratory tests, there is generally no beneficiary cost sharing under Original Medicare.

To ensure the public has clear information on coverage and benefits under CMS programs, the agency also released three fact sheets that cover diagnostic laboratory tests, immunizations and vaccines, telemedicine, drugs, and cost-sharing policies.

Medicare Fact Sheet Highlights: In addition to the diagnostic tests described above, Medicare covers all medically necessary hospitalizations, as well as brief "virtual check-ins," which allows patients and their doctors to connect by phone or video chat.

Medicaid and Children's Health Insurance Program (CHIP) Fact Sheet Highlights: Testing and diagnostic services are commonly covered services, and laboratory and x-ray services are a mandatory benefit covered and reimbursed in all states. States are required to provide both inpatient and outpatient hospital services to beneficiaries. All states provide coverage of hospital care for children and pregnant women enrolled in CHIP. Specific questions on covered benefits should be directed to the respective state Medicaid and CHIP agency.

Individual and Small Group Market Insurance Coverage: Existing federal rules governing health insurance coverage, including with respect to viral infections, apply to the diagnosis and treatment of with Coronavirus (COVID-19). This includes plans purchased through HealthCare.gov. Patients should contact their insurer to determine specific benefits and coverage policies. Benefit and coverage details may vary by state and by plan. States may choose to work with plans and issuers to determine the coverage and cost-sharing parameters for COVID-19 related diagnoses, treatments, equipment, telehealth and home health services, and other related costs.

Summary of CMS Public Health Action on COVID-19 to date:

On March 4, 2020, CMS issued a call to action to healthcare providers nationwide to ensure they are implementing longstanding infection control procedures and issued important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare facilities to focus exclusively on issues related to infection control and other serious health and safety threats. For more information on CMS actions to prepare for and respond to COVID-19, visit: CMS Announces Actions to Address Spread of Coronavirus.

On February 13, 2020, CMS issued a new HCPCS code for healthcare providers and laboratories to test patients for COVID-19 using the CDC-developed test. For more information about this code: Public Health News Alert: CMS Develops New Code for Coronavirus Lab Test.

On February 6, 2020, CMS issued a memo to help the nation's healthcare facilities take critical steps to prepare for COVID19.

On February 6, 2020, CMS also gave CLIA-certified laboratories information about how they can test for SARS-CoV-2. Read more: Suspension of Survey Activities memorandum

For the updated information on the range of CMS activities to address COVID-19, visit the Current Emergencies webpage.

Special Edition - Wednesday, March 4, 2020

CMS Announces Actions to Address Spread of Coronavirus