Aside from the medical flurry of this pandemic, there is a burst of financial activity. This is a quick summary of the actions related to a regulation issued today by CMS and  “older” pandemic legislation. SCAI has been actively urging Congress to take these and other actions.

Regulatory Changes Liberalize Telehealth Billing and Allow for Retroactive Billing

On April 30, 2020 CMS issued an interim final rule designed to:

  • “expand the healthcare workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community or other states;
  • ensure that local hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites (also known as the CMS Hospital Without Walls initiative);
  • increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home;
  • expand at-home and community-based testing to minimize transmission of COVID-19 among Medicare and Medicaid beneficiaries; and
  • put patients over paperwork by giving providers, healthcare facilities, Medicare Advantage, and Part D plans, and states temporary relief from many reporting and audit requirements so they can focus on patient care”

The telehealth changes are probably the most important for interventional cardiologists. CMS now allows:

  • allow retroactive billing to March 1, 2020, for telehealth services
  • relax rules about where a telehealth service needs to be billed from (perhaps avoiding concerns about licensure in the state where the patient is located,
  • allowing audio-only telehealth services and increasing the payment rates

General Distribution to Healthcare Providers

The Department of Health and Human Services is beginning to distribute the second batch (aka tranche) of funds from the $100 billion in funds to healthcare providers impacted by the coronavirus response. The first batch was $30 billion and distributed based on the providers' 2019 Medicare reimbursements (about 6% of providers 2019 Medicare reimbursements). The second batch of $20 billion will be distributed to providers based on their total 2018 reimbursements. The first tranche was skewed toward providers who provided more of their care to Medicare patients. This second tranche will even out the funding among all providers based on their total 2018 revenue. So, the higher your percentage of revenue that comes from Medicare, the less you will receive in this second tranche.

The first round of funding required no actions (besides signing an attestation by providers) but the second batch will require that providers apply for these funds. Most physicians will need to submit their revenue information to the General Distribution Portal for additional general distribution funds. Anyone who has a Billing TIN who lost revenue in March and/or can estimate lost revenue in April due to the COVID-19 crisis should be filling out this portal. The AMA is referring physicians to a guide to this process.

The Department has also posted answers to frequently asked questions.


Small Business Loans

The Small Business Loan Program (aka the Paycheck Protection Program) has gotten a $320 billion bolus. These loans will be forgiven if the recipients meet certain criteria. It is not clear how long that will last so signing up quickly is very important. More information is available on the SBA’s website. The AMA has good guidance on filing claims.


Accelerated Payment Program and Advance Payment Program

These programs were designed as short-term loan programs for isolated problems such as hurricanes and CMS wants these loans repaid. They have lent over $100 billion. On April 26 CMS announced it is reevaluating the Accelerated Payment Program and suspending the Advance Payment Program for suppliers (not physicians). CMS is not accepting any new applications for the Advance Payment Program, and it is reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through the Department of Health & Human Services’ (HHS) Provider Relief Fund. For more information


Other Relief

The Health Resources and Services Administration is providing additional funds to physicians to treat uninsured patients with COVID-19. Additional funds are also being distributed to small lenders, health care facilities, and to COVID-19 testing.


Future Legislation

While some Republican legislators are suggesting a pause in pandemic legislation, the President and House Democrats are actively drafting such legislation. It is likely to be broader than previous pandemic legislation, focusing more on the economic downturn and probably including infrastructure funding as well as aid to States and localities.