Biden Administration to End COVID-19 PHE on May 11

Originally published in the February 2, 2023, issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

The Biden Administration announced that it plans to end the COVID-19 public health emergency (PHE) on May 11, 2023. This decision comes after multiple renewals over the past three years. MGMA appreciates that the Administration heeded our call to provide at least 90-days’ notice prior to concluding the PHE. The end of the PHE will have ramifications for a variety of flexibilities afforded by the pandemic over the last several years, such as HIPAA penalty waivers, controlled substance prescription waivers, and COVID-19 testing and treatment coverage.

For more information on the flexibilities that will conclude along with the PHE, download MGMA’s member-exclusive resource.

COVID-19 PHE Renewed

Originally published in the January 12, 2023, issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) yesterday. This renewal extends the PHE through mid-April 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. HHS has reiterated its promise to give a 60 days’ notice before letting the PHE expire.

While many telehealth flexibilities are tied to the PHE, it is important to note that the recently passed Consolidated Appropriations Act, 2023, does ensure certain ones will remain in effect through Dec. 31, 2024, regardless of PHE status.

More information may be found in MGMA Government Affairs’ newly updated telehealth resource.

Medicare Finalizes 2023 Payment and Quality Reporting Changes

Originally published in the November 1, 2022, issue of MGMA’s MGMA Regulatory Alert
Reprinted with permission from MGMA

The Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule this afternoon, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2023. The final rule:

  • Sets 2023 Medicare payment rates for physician services. For 2023, CMS finalized a conversion factor of $33.0607 and $20.6097 for Anesthesia (a decrease of -4.47% and -4.42%, respectively, over final 2022 rates);
  • Finalizes implementation of provisions of the Consolidated Appropriations Act, 2022 that extend the application of certain Medicare telehealth flexibilities for an additional 151 days after the end of the COVID-19 public health emergency (PHE), such as allowing telehealth services to be furnished to patients in their homes;
  • Extends flexibilities to permit split/shared E/M visits to be billed based on one of three components (history, exam, or medical decision making) or time until 2024;
  • Expands access to behavioral health by permitting marriage and family therapists, licensed professional counselors, and others to furnish behavioral health services under general supervision instead of direct;
  • Maintains the MIPS performance threshold at 75 points for the 2023 MIPS performance year/2025 payment year;
  • Adds five new MIPS Value Pathways related to nephrology, oncology, neurological conditions, and promoting wellness, for voluntary reporting beginning in 2023; and
  • Creates an advanced incentive payment pathway for certain low-revenue, new entrant accountable care organizations to bolster participation in the Medicare Shared Savings Program.

MGMA submitted detailed comments in response to the proposed rule in September. Be on the lookout for a more detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP) in the coming weeks.

Additional information about the final rule is available in the PFS fact sheet and the QPP fact sheet.

Updated COVID-19 Booster Becoming Available for Kids 5-11

October 13, 2022 – North Carolina Department of Health and Human Services (NCDHHS)

Everyone 5 and older can now receive the updated COVID-19 booster, specifically made to protect against the latest COVID-19 variants. The new booster is available for kids 5 to 11 in North Carolina following the Food and Drug Administration’s emergency use authorization and the Centers for Disease Control and Prevention’s recommendation.

The updated booster is referred to as a bivalent vaccine, as it targets both the original coronavirus strain and the Omicron BA.4 and BA.5 variants. As of mid-September, these variants made up approximately 80% of COVID-19 cases in North Carolina. Everyone 5 and older should get the updated COVID-19 booster two months after they finish their primary series or any booster dose.

For more information about COVID-19 vaccines, boosters, testing and treatments, or to find locations to get a COVID-19 and flu vaccine, visit MySpot.nc.gov or contact the North Carolina COVID-19 Vaccine Help Center by phone at 888-675-4567.

FDA EUA & CDC Recommendation: Pfizer 6m-4y and Moderna 6m-5y

The following update information concerning vaccine rollout in North Carolina was provided by Ryan Jury, RN, MBA, COVID-19 Vaccine Program Director, Division of Public Health, North Carolina Department of Health and Human Services:

  1. State Provider Communication sent on Tuesday, June 21st.
  2. State Press Release from Saturday
  3. The provider/community toolkit will be released in the coming days.
  4. The Statewide Standing Order FDA EUA Pfizer 6m-4y and Moderna 6m-5y are now published online and available.
  5. Please read and review the Fact Sheet for Healthcare Providers:

NCDHHS Under 5 COVID-19 Vaccine Updates

On the evening of June 1st, the North Carolina Department of Health and Human Services (NCDHHS) released an important email regarding ordering the under-five COVID-19 vaccine products. The email provides details on the roll out plan as well important dates and requirements.

Smarter Connections with Life Science Experts

2022 Alliance sponsor feature article courtesy of RxVantage

The pace of change in today’s medical practices is tremendous: agile workflows, telehealth, and remote monitoring technologies are a small part of the new reality fueled by COVID-19. This is in addition to new indications and protocols for existing drugs, novel cutting-edge medical technology, and innovative clinical trials. According to an article published by Elsevier Connect, it’s estimated that the body of medical knowledge doubles every 73 days. Combined with the chaos of the pandemic, medical practices have reconsidered the most efficient way to engage with life science experts to drive smarter and more timely decisions for their patients and practice.

One area that practices have historically had issues managing is visitations from life science experts. Life science experts are a vital source of information for all practices, providing information on new product development, clinical trial results, patient assistance programs, and so much more. However, many times these experts are unscheduled, which means practice clinicians may not be able to get the vital information they need, and similarly, life science experts leave without ever meeting with the providers. The friction posed by this lack of synergy for both the life science expert and provider workflow can mean canceled meetings – meetings which are vital in keeping physicians up-to-date with product information – and potentially prolonging patient treatment decisions.

RxVantage user, Childs Dermatology, a dermatology practice in Texas, notes “It is important for us to get updated information, including which new drugs are coming out, what they’re for, and who can—and can’t— get them,” says Raquel Frausto, medical assistant. Frausto mentions the benefits she’s experienced from adding RxVantage’s online platform to their practice, including being able to rely on timely and relevant education from life science reps throughout COVID-19. On implementing the platform in her office, Frausto says, “I really love the ease of the life science reps being able to schedule meetings themselves without having to ask me first. That’s one less thing I have to worry about.”

RxVantage understands that smarter connections with life science resources and experts help practices improve patient care. To do this, practices must take advantage of tools that streamline communications, logistics and meetings with life science experts. Additionally, in a post-COVID world, practices need tools that give them the ability to hold online meetings that are equally productive and informative as those held in person.

Based on feedback from the practices in our network, we have created those tools to help offices run efficiently and ensure that HCPs receive timely information. RxVantage was created to give HCPs and practice managers a smarter way to communicate with life science experts, schedule meetings, and receive information on-demand and on their terms. Our rep directory provides practice managers and staff with updated pharma rep and life science expert contact information. Further, to ensure that meetings with life sciences experts aren’t missed due to a lack of communication about office policy, practices and pharmaceutical reps may use the In-Office Policy Builder to maintain alignment. Life science experts can also serve various other practice staff, including billers and coders. These non-clinical staff often need timely and up-to-date reimbursement information that supports revenue cycle management.

The global pandemic placed unparalleled demands on the healthcare industry, but two things have remained constant among HCPs’ priorities: patient care and maintaining their medical knowledge to treat them. Having the tools to make smarter connections that expand and accelerate your office’s on-demand access and ability to engage with life science experts results in smarter and more timely decisions for your patients and practice.

Visit RxVantage.com for more information on how your office can enroll.

About RxVantage

RxVantage transforms how medical practices engage with life science resources and expertise. Through automation, customization, and technology, RxVantage gives practices smarter connections to innovative solutions that are powering patient care. Our apps intelligently connect healthcare providers with the precise life science resources that they need, when they need them. As a result, medical practices stay on the cutting edge of patient care without disrupting workflows

Medicare Telehealth Waivers

Updated March 1, 2022 Courtesy of MGMA

In 2020, the Department of Health & Human Services (HHS) instituted flexibilities that waived many of the generally applicable rules governing Medicare telehealth services in response to the COVID-19 pandemic. Many of these waivers are in effect through the duration of the COVID-19 public health emergency (PHE). Once the PHE concludes, many of these flexibilities will end without further congressional or regulatory action. The COVID-19 PHE is currently in effect through April 16, 2022. Please keep in mind that this resource addresses Medicare payment policy, and that Medicaid and commercial payers may institute their own payment rules.

Urgent Practice Data Survey – August Medicaid Transformation Focus

August Survey Refresh!
Medicaid Transformation Questions Included

Your practice response is needed!

NCMGMA, NCMS, and Curi continue working together to gather essential practice information from administrators and clinicians across North Carolina relative to the current COVID crisis.

We know this is a stressful and uncertain time, but by taking less than 5 minutes to complete this survey, you are allowing us to better respond to and represent your needs from COVID to new protocols, telehealth issues, and now Medicaid Transformation. Please click the link above to take this short survey.

Thank you for your time and for your commitment to your communities. We’re in this together and are proud to support you and all North Carolinas in your practice through this tumultuous season.

Your Colleagues at NCMGMA, NCMS, and Curi


Please click on the links below to access our other Urgent Practice Data Survey Summary and Data Trends reporting:

COVID-19 Vaccine Summary Report – Week of March 15th
COVID-19 Vaccine Summary Report – Week of January 18th
2020 UPDS Summary Report
Urgent Practice Data Survey – Sixteen Week Summary Report
Urgent Practice Data Survey – Practice Well-being Report
Urgent Practice Data Survey – Reopening NC Healthcare Practice Report
Urgent Practice Data Survey – Telehealth Data Summary Report
Urgent Practice Data Survey – NC Practice Financial Report
Urgent Practice Data Survey – Summary Report
Urgent Practice Data Survey – Trends Report
COVID-19 Practice Protocols Report

Recording: August 26th Lunch & Learn Webinar

August Lunch & Learn Webinar Recording
Second-Order Threats: Preparing for the Downstream

Effects & Risks of COVID-19

On Thursday, August 26th, Donna H. Nicholson, MBA, BSN, RN, CPCO, Senior Vice President of Risk Management at Curi, addressed the second-order impacts of the COVID-19 pandemic and the importance of beginning to prepare to mitigate the downstream effects of the global crisis while taking the necessary steps to ensure the continued success of our practices.

Thank you to Donna Nicholson and to all of our webinar participants. Also, a big thank you to Curi for sponsoring this webinar.

Please click on the blue button link below to access the webinar recording. The passcode is F#JVEx7N. You can access a PDF copy of the webinar handouts here.

Questions

For questions, please contact the NCMGMA offices at info@ncmgm.org.