August 2020
Proposed policy, payment and quality provisions changes to the Medicare physician fee schedule for 2021
On Aug. 3, 2020, the Centers for Medicare and Medicaid Services (federal CMS) issued a proposed rule that includes updates to payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after Jan. 1, 2021. At the same time, the Trump administration issued an Executive Order on Improving Rural and Telehealth Access. Here are a few takeaways from the 1,355-page rule.

  • The proposed CY 2021 PFS conversion factor is $32.26, a significant decrease of $3.83 below the CY 2020 PFS conversion factor of $36.09 (an 11 percent decrease compared to last year).
  • The federal CMS proposes to implement finalized CPT descriptors, guidelines and payment rates for evaluation and management (E/M) services on Jan. 1, 2021, which will be a significant modification to the coding, documentation, and payment of E/M services for office visits. While the agency recognized the increases in the payment bundles for maternity care and a few other select services, the visits within the 10-day and 90-day global surgical payment bundle remain unchanged. Read more on E/M changes from the AMA here.
  • The executive order and proposed rule aim to expand payment for telehealth for Medicare beneficiaries permanently, beyond the COVID-19 public health emergency.
  • The federal CMS proposes to continue to gradually implement MIPS in 2021 and postpones the MIPS Value Pathways participation option until 2022 at the earliest.
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Provider reimbursement available for counseling patients to self-isolate at time of COVID-19 testing
The Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention will pay physicians and health care providers to counsel patients at the time of COVID-19 testing about the importance of self-isolation after they are tested and prior to the onset of symptoms. 

This counseling will include the discussion of immediate need for isolation, even before results are available, the importance to inform their immediate household that they too should be tested for COVID-19, the review of signs and symptoms of the virus, and services available to them to aid in isolating at home. In addition, they will be counseled that if they test positive, to wear a mask at all times, that they will be contacted by public health authorities and asked to provide information for contact tracing, and to tell their immediate household and recent contacts in case it is appropriate for these individuals to be tested for the virus and to self-isolate as well. The federal CMS will use existing evaluation and management payment codes to reimburse providers who are eligible to bill for counseling services no matter where a test is administered, including doctor’s offices, urgent care clinics, hospitals, and community drive-thru or pharmacy testing sites.

More information:

HHS provider relief fund Phase 2 General Distribution now accepting additional applicants through Aug. 28
On July 31, 2020, U.S. Department of Health and Human Services (HHS) announced that certain Medicare providers will have more time to apply to receive additional Provider Relief Fund payments. These are providers who previously missed the June 3, 2020 deadline to apply for additional funding equal to 2 percent of their total patient care revenue from the $20 billion portion of the $50 billion Phase 1 General Distribution, including many Medicaid, Children's Health Insurance Program (CHIP), and dental providers with low Medicare revenues. In addition, certain providers who experienced a change in ownership, making them previously ineligible for Phase 1 funding, will also be given an opportunity to apply for financial relief. The new deadline is Friday, Aug. 28. Visit the providers webpage for key facts and steps for how to apply, see the Medicaid provider FAQs, or read the press release.
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Colorado QPP Coalition: August 2020 Fast Facts
The Colorado Quality Payment Program Coalition has released the August 2020 QPP Fast Facts, providing great information you need in a condensed format that allows for quick reading.

In this month's edition:
  • Now Available: 2019 MIPS Performance Feedback and Final Score
  • Now Available: 2019 MIPS Targeted Review
  • CMS Releases 2021 Proposed Rule for the Quality Payment Program
  • CMS Announces Relief for Clinicians Participating in the Quality Payment Program in 2020
  • Upcoming Deadlines
  • Upcoming Events
  • CMS QPP Resources

Dr. Ashby Wolfe is presenting on the CO QPP Coalition Office Hours - Aug. 25
The Colorado QPP Coalition has an exciting event planned in August! Ashby Wolfe, MD, regional chief medical officer for the Centers for Medicare and Medicaid Services, will present during for the Colorado QPP Coalition August Office Hour event on Tuesday, Aug. 25 at 12 p.m. MT. Join COQPP to learn about the changes to the Quality Payment Program for 2021 in the Proposed Physician Fee Schedule Rule that was just released on Aug. 17, 2020. Don’t miss this opportunity to share feedback and ask questions directly to our CMS regional representative. Register here.
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HCPF webinar: Ensuring Appropriate Claims Payment
Implementation of Ensuring Appropriate Claims Payment project is anticipated to begin in late September. Providers are reminded this project has two components: implementation of ClaimsXten and improvements to the 3M EAPG Grouper. More information can be found in the August Medicaid bulletin or through a brief, recorded informational webinar. The webinar provides a high-level walkthrough of the purpose, timeline and implementation of the Ensuring Appropriate Claims Payment project. Frequently Asked Questions have been published on the project webpage. Email HCPF_ClaimsXten@state.co.us with additional questions.
Join HCPF for Provider Leader Webinars; next event Aug. 20
The Department of Health Care Policy and Financing is hosting monthly provider webinars on the third Thursday of the month from 12 - 1 p.m. The remaining dates for the provider webinars will be Aug. 20, Sept. 17, Oct. 15, Nov. 19 and Dec. 17, 2020. These webinars will cover key updates from the Department on COVID-19 and other implementation updates and be a forum to discuss what the new normal in health care may look like following the pandemic. HCPF encourages you to save the dates and attend if you can. If you are not able to make the webinar, the meetings will be recorded and posted online to view later. This virtual meeting will be held at this link. Find more information in the Provider Leader Resource Center: Colorado.gov/hcpf/provider-leader-resource-center.
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