Category Archives: Practice Enhancement

What Private Practices Need to Know About the U.S. Relief Package

April 15, 2020

There is a dire need for financial support of healthcare providers and facilities as they continue to battle the COVID-19 pandemic, now affecting the United States the most drastically. In response, the President signed the bipartisan CARES Act on March 27, 2020, providing much-needed relief funds to hospitals and other healthcare providers on the frontlines of the fight against coronavirus. As part of the recently announced CARES Act, $100 billion will be appropriated to create a Public Health Social Service Emergency Fund with an ultimate goal of preventing, preparing for, and responding to the coronavirus outbreak both domestically and on an international scale.

Per the Act, funding will be dedicated to reimbursing healthcare-related expenses or lost revenue attributable to COVID-19 to alleviate some of the financial burden many providers are experiencing. Part of this relief payment will focus on ensuring that uninsured Americans have access to testing and treatment, and that medical professionals providing the care are reimbursed for their work. The Department of Health and Human Services has published detailed criteria for the process of distribution of funds under the Act as well as information about eligibility requirements, outlined below.

Immediate Relief Funding

Recognizing the urgent need for the delivery of financial relief, the HHS immediately infused $30 billion into the American healthcare system. Payments are slated to arrive via direct deposit beginning April 10, 2020 to eligible providers throughout the system. Note, these are direct payments, not loans and will not need to be repaid, the HHS emphasizes.

Eligibility for Immediate Relief Payments

Per guidance from the HHS, all facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible to receive payments from this initial rapid distribution. Payments to practices that are part of larger medical groups will be sent to the group’s central billing office, while all relief payments will be made to the billing organization according to its Taxpayer Identification Number (TIN).

In order to be eligible to receive these funds, providers must not seek to collect of out-of-pocket payments from a COVID-19 patient that are greater than what they would be otherwise had the care been provided by an in-network practitioner. If a practice had to halt business operations as a result of the COVID-19 outbreak, providers may still be eligible to receive funds if they provided diagnoses, testing, or care for patients with possible or confirmed cases of COVID-19. Per the HHS, “Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.”

The immediate relief payments hope to alleviate providers in hard-hit COVID-19 areas and those who are struggling to keep their practice open due to delayed care and widespread cancellations of elective procedures.

Payment Distributions 

Payment distributions will be based on the provider’s or practice’s share of total Medicare FFS reimbursements for the year 2019; that year, the total FFS payments were approximately $484 billion. Providers can estimate their anticipated payment by dividing their 2019 Medicare FFS (excluding Medicare Advantage) payments – which can be obtained from their organization’s revenue management system – by $484 billion and multiplying that ratio by $30 billion. 

Receiving Payments

In partnership with UnitedHealth Group (UHG), the HHS will provide rapid payments to eligible providers, as described above, to distribute the initial round of funding. Providers will be paid via their Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS) and can expect to receive payments via Optum Bank with “HHSPAYMENT” as the payment description. Providers who receive reimbursements from CMS via paper check can expect to receive a paper check in the mail within the next few weeks.

Providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment within 30 days of receipt. The Terms and Conditions of the funding can be found on the CMS website. If the payment is not returned within 30 days, the HHS will view this as an acceptance of the Terms and Conditions. However, if a provider does not wish to comply with the Terms and Conditions, they must contact HHS within 30 days of receipt of payment and then return the full payment to HHS.

Different Types of Providers

All relief payments are being made to providers according to their tax identification number (TIN). Large organizations will receive payments for each of their billing TINs that bill Medicare, and should look to the part of their organization that handles Medicare billing to identify details on Medicare payments for 2019. Employed physicians should not expect to receive an individual payment directly; instead, their employer’s organization will receive the relief payment as the billing organization. Similarly, individual physicians and providers in a group practice are unlikely to receive individual payments directly; the group practice will receive the relief fund payment as the billing organization. Solo practitioners who bill Medicare will receive a payment under the TIN they use to bill Medicare.

The Remaining $70 Billion 

As part of the $100 billion guaranteed by the CARES Act, the remaining $70 billion will be comprised of targeted distributions focused on providers in areas particularly impacted by the virus, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, as well as providers requesting reimbursement for the treatment of uninsured Americans. More guidance is expected on the structure of these payments in the coming weeks.

COVID-19 Medical Expenses

The federal government is taking measures to ensure Americans are not surprised by medical expenses and are protected against financial obstacles that might prevent them from seeking care or getting tested and treated for COVID-19. A portion of the Provider Relief Fund will be used to reimburse healthcare providers at Medicare rates for COVID-related treatment of the uninsured. However, providers are prohibited from “balance billing” any patient for COVID-related treatment in order to be eligible.

In addition, the Families First Coronavirus Response Act requires private insurers to cover an insurance plan member’s cost-sharing payments for COVID-19 testing. Further, the government has secured commitments from private insurers – such as Humana, Cigna, UnitedHealthGroup, and the Blue Cross Blue Shield system – to waive cost-sharing payments for treatment related to COVID-19 for its members and make medical care more accessible.

Heavily anticipated by providers across the nation, the latest guidance helps to clarify eligibility, distribution, and payment concerns regarding the Provider Relief Fund. Eligible practices and providers may soon expect to receive payments from the immediate round of funding. In the meantime, medical professionals can access more information about and the latest developments concerning the CARES Act Provider Relief Fund here.

COVID-19 Insurance Coverage Changes

April 9, 2020

Requiring a coordinated response from the government, healthcare system, and private sector, the COVID-19 outbreak has placed an unprecedented burden and stress on countries across the globe. In the United States, federal policies are being updated rapidly in response to the shifting demands of the healthcare system as it fights to curb the virus. As such, insurance providers are playing a critical role in ensuring widespread access to care and have taken decisive action to help both patients and providers in combating the novel coronavirus.

From state insurance regulators, who are limiting the amounts patients can owe for COVID-19 care, to insurance companies and employers who have amended many rules to eliminate deductibles and co-payments, coverage changes have been occurring on a large scale. As the outbreak is developing and dynamically changing the medical landscape, below are some of the latest policies to go into effect in response to COVID-19.

COVID-19 Testing

Per the latest legislation passed by Congress, coronavirus testing is free for all individuals regardless of insurance status – as is the cost of a doctor’s visit or trip to the emergency room to receive the test. The recently passed Families First Coronavirus Response Act requires all group health plans and individual health insurance providers to cover testing and associated visits related to the diagnosis of COVID-19. In addition, several states, including California, New York, and Washington have implemented additional requirements on insurance companies to cover testing costs.

Both private insurance companies and employers have volunteered to waive the costs of testing. In addition, the Families First Coronavirus Response Act requires most private health companies to cover testing for COVID-19.

Medicare and Medicaid will also cover the costs of a coronavirus test, while the uninsured should also be able to get tested at no cost per the latest guidelines. Patients who recently lost their jobs may qualify for Medicaid or be able to sign up for a health plan under the Affordable Care Act to gain access to free testing.

COVID-19 Treatment Costs

In response to the COVID-19 outbreak, health insurance providers are waiving out-of-pocket costs for hospital visits and many are funding treatment of COVID-19 as well. Cigna and Humana have waived out-of-pocket costs for treatment, as have Aetna, Florida Blue, Harvard Pilgrim and UnitedHealth Group. One of the largest insurers in the nation, Blue Cross and Blue Shield, covers nearly 6 million individuals under its Federal Employee Program and has said it would waive co-payments and deductibles for medically necessary treatment.

Although, there are restrictions to the coverage of treatment costs as some insurers have waived cost sharing only for the upcoming two months while others have eliminated expenses only for hospital stays. In addition, it remains unclear how much patients may be required to pay out of pocket; the Kaiser Family Foundation estimates COVID-19 care can cost around $20,000, bringing potential out-of-pocket bills to around $1,300 depending on the patient’s plan, location of care, and disease severity.

COVID-19 Complications Care

Most private insurance plans will likely cover services needed to treat COVID-19 complications although, there is currently no federal guidance requiring them to do so. In addition to covering testing, Medicare will cover both outpatient and hospitalization services. During the COVID-19 crisis, Medicare patients are covered if they need to be transferred to skilled care regardless of previous hospitalization. However, the program does not cover long-term stays in long-term care facilities at this time.

Telemedicine Coverage

According to the latest policy changes, telehealth will now be covered under Part B for all traditional Medicare enrollees for services not limited to COVID-19 care. The definition of telemedicine will be expanded to allow patients to connect with healthcare providers from their homes via video conferencing or other digital methods. To further ease access to care, the requirement that telemedical care be provided by a medical professional the patient has seen within the last three years has been waived.

The widespread shift to telehealth has proven critical to easing the burden on the U.S. healthcare system by “allowing hospitals to care for people who need it most, while limiting the exposure of health care workers and patients to the disease,” explains a one-pager published by America’s Health Insurance Plans. “Telehealth is especially beneficial for patients who are at a higher risk when leaving the home to commute to the doctor’s office.”

Out-of-Network Bills

Despite the significant efforts made toward expanding insurance coverage at this time, patients may still be required to pay out-of-network bills, for example, when they are treated by an out-of-network physician. Data from the Kaiser Family Foundation indicate that nearly one in five patients admitted to the hospital with serious cases of pneumonia were faced with out-of-network bills after treatment. To further ease patients’ financial burden related to COVID-19, some hospital systems are pausing collections for the foreseeable future.

Alongside the aforementioned updates, many insurance coverage providers are proposing further changes to expand coverage and ease the financial burden during this COVID-19 crisis. Healthcare providers should remain current on the latest developments in coverage policies as they may affect both themselves as well as their patients.

For further assistance with navigating the changing insurance coverage landscape, the America’s Health Insurance Plans’ website offers a comprehensive list of providers and their responses to COVID-19, which can be accessed here.

Mental Health Tips for Clinicians During COVID-19

April 6, 2020

In the difficult time of the novel coronavirus outbreak, the healthcare industry and its dedicated professionals are working around the clock to treat patients and prevent the further spread of the infection. As the first line of defense against the disease, physicians must maintain not only their physical health by practicing current safety practices, but also protect their mental health despite rising stress levels, long work hours, and prevailing uncertainty. In an effort to ease the psychosocial symptoms accompanying the epidemic, a recent article published in Medical Economics outlines several suggestions for physicians and other care providers to help them cope during this extremely demanding period.

Manage Stress Levels 

Managing stress levels and psychological wellbeing is as essential during this time as ever. High-pressure conditions have been directly tied to negative effects on physical health; increased cortisol production has a well-established relationship with decreased immune system functioning. Although health care providers are likely to be experiencing severe levels of stress at this time, simple coping techniques can provide relief. To help alleviate stress, professionals are encouraged to ensure a healthy diet, adequate sleep, and the use of relaxation techniques – all of which can help clinicians cope with the increased demands of their jobs at this time while having positive effects on their overall wellbeing.

Prioritize Basic Needs

As mentioned above, ensuring adequate rest during work hours or between shifts as well as eating sufficient amounts of healthy food are basic necessities for coping in a time of emergency. Other positive strategies include engaging in physical activity when possible and staying in close contact with family and friends. Clinicians are urged to avoid employing adverse coping mechanisms, such as tobacco, alcohol, or other drug use as these can worsen mental and physical health in the long term and make the current situation more difficult to handle.

Stay Connected

During a period of required social distancing and isolation, it is vital to maintain contact with family, friends, and colleagues to ensure access to social support. Staying connecting throughout the day has never been easier with digital technologies facilitating constant contact and allowing people to remain in touch despite physical distancing.

As it may be difficult for healthcare providers to see their loved ones or maintain physical contact for fear of spreading the infection, it is crucial to call, FaceTime, message, and reach out in other ways. It is also important to ensure diverse forms of communication are being used – that do not solely rely on written words – to connect with individuals with intellectual, cognitive, and psychosocial disabilities, especially if you are a team leader or manager in a healthcare facility.

Work Together

Ensuring good quality communication across staff members can facilitate working together during this time. Individuals in managerial positions are encouraged to support the mental health of medical professionals in any way they can. This should include rotating workers from high-stress to lower-stress functions to ensure they can get adequate rest. Inexperienced workers should be paired with more experienced employees to help provide support, monitor stress, and reinforce safety procedures. Further, healthcare providers should be encouraged to take breaks, while flexible schedules should be implemented for workers who are directly or indirectly impacted by the COVID-19 infection.

Promote Access to Support Services

Team leaders and managers of healthcare facilities are asked to ensure their staff has access to mental health and psychosocial support services, not only during these difficult times but at all other times as well. While individuals in leadership positions can and should provide positive role models for self-care strategies to help mitigate stress, they are not immune to the psychological toll of the COVID-19 outbreak. It is important to remember that these individuals are also be experiencing increased levels of stress and feelings of pressure, requiring access to support services as well.

Educating medical professionals on how to provide basic emotional support to affected people and each other using psychological first aid is a necessary step. Some strategies include speaking and acting calmly, creating connections and building relationships, as well as encouraging mindfulness via proven relaxation techniques. A more comprehensive guide to psychological first aid can be found here.

Beyond combating the coronavirus outbreak, a current priority is ensuring the physical safety and mental health of healthcare providers worldwide. Managing stress, connecting with others, and making sure to prioritize basic needs in this emergency situation can help drive positive outcomes for both providers and their patients, who need the support of the healthcare workforce more than ever.