Administration Extends Public Health Emergency Due to the COVID-19 Pandemic
On October 1, U.S. Department of Health & Human Services (HHS) Secretary Alex Azar announced he is extending the public health emergency another 90 days. This latest extension takes effect on October 23 and will expire on January 20, 2021.
Over 100 Members of the House of Representatives Have Signed the Bera/Bucshon letter to the House Leadership Urging Action to Prevent the Medicare Physician Payment Cuts Scheduled to Take Effect on January 1, 2021; Deadline Extended to October 16
To date, over 600 letters have been generated by ASCRS and ASOA members urging their congressional representatives to sign the bipartisan congressional sign on letter to the House leadership being led by Representatives Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN). The letter urges the leadership to address the pending Medicare physician payment reductions before the end of the year. Due to the grassroots effort, we now have over 100 members of the House of Representatives who have signed the letter. The deadline for signatures has been extended to October 16.
If you have already reached out to your representative, thank you. If you have not, please use the ASCRS Grassroots Action Center to send your letter. All you have to do is sign in – provide your zip code and the background information and a letter will pop-up. You may personalize the letter before sending.
It is important that members of Congress hear directly from you. They need to hear how these cuts will impact you, your practice, and your patients.
Thanks again for your participation!
CMS Announces New Repayment Terms for the Medicare Accelerated and Advance Payment (AAP) Program Loans
On October 8, The Centers for Medicare & Medicaid Services (CMS) announced amended terms for payments issued under the AAP Program as required by recent action by the administration. Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment.
Providers were originally required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after the payment was issued. After the first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during the time period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.
The letter also provides guidance on how to request an Extended Repayment Schedule (ERS) for providers and suppliers who are experiencing financial hardships. An ERS is a debt installment payment plan that allows a provider or supplier to pay debts over the course of three years, or, up to five years in the case of extreme hardship. Providers and suppliers are encouraged to contact their Medicare Administrative Contractor (MAC) for information on how to request an ERS. To allow even more flexibility in paying back the loans, the $175 billion issued in Provider Relief funds can be used towards repayment of these Medicare loans. CMS will be communicating with each provider and supplier in the next couple of weeks as to the repayment terms and amounts owed as applicable for any accelerated or advance payment issued.
Phase 3 General Distribution from the Provider Relief Fund – Portal for Applications Now Open; Deadline to Apply is November 6
The new Phase 3 General Distribution is designed to balance an equitable payment of 2 percent of annual revenue from patient care for all applicants plus an add-on-payment to account for revenue losses and expenses attributable to COVID-19.
HHS has also provided detailed information on its website about how to apply for funding and the definition of “provider.”
It is important to note that the reporting portal for the use of the Provider Relief funds will not open until mid-January, and the first report will be due mid-February.
Key dates:
- January 15, 2021: reporting system opens for all providers
- February 15, 2021: first reporting deadline for all providers on use of funds
- July 31, 2021: final reporting deadline for providers who did not fully expend Provider Relief funds prior to December 31, 2020
ASCRS Joins OOSS, ASRS, and SEE in Submitting Comments on the Proposed ASC Payment Rule for 2021
On October 5, ASCRS joined the Outpatient Ophthalmic Surgery Society (OOSS), the American Society of Retina Specialists (ASRS), and the Society for Excellence in Eyecare (SEE) in comments to the Centers for Medicare and Medicare Services (CMS) on the proposed ASC Payment Rule for 2021.
Specifically, the comments urge the agency to permanently use the Hospital Market Basket as the ASC annual update factor; apply the full Hospital Outpatient Department (HOPD) relative weights to ASC services, and remove FDA-approved drugs with a post-operative indication that are currently considered supplies, out of the facility bundle and pay separately under Medicare Part B. In addition, we express continued support for the proposed ASC quality measure for TASS.
ASCRS Joins E/M Coalition in Comments to CMS Focused on the Proposed 10.6% Reduction to the Medicare Physician Payment Conversion Factor for 2021; Request Action by CMS to Prevent the Cuts
ASCRS joined 46 other physician and provider organizations in a comment letter to CMS focused on the Evaluation and Management (E/M) changes included in the proposed Medicare Physician Payment Fee Schedule for 2021 that are resulting in a unprecedented payment cut to surgical and other specialties as a result of the budget neutrality adjustment to the conversion factor.
The letter urges the agency to use its waiver authority under the public health emergency to eliminate or mitigate the impact of the budget neutrality reduction, eliminate the unnecessary add-on code (GPC1X), and include the negative impact of COVID when calculating the E/M utilization projections, among other requests.
Applications for the 2020 Promoting Interoperability Hardship and Extreme and Uncontrollable Circumstances Exception Due December 31
If you are plan on applying for a Merit-based Incentive Payment System (MIPS) Promoting Interoperability Hardship Exception or Extreme and Uncontrollable Circumstances Exception for the 2020 Performance Year of MIPS, you must submit your application to CMS by Thursday, December 31, 2020 at 8:00 p.m. ET.
Who is Eligible for a MIPS Promoting Interoperability Hardship Exception?
MIPS eligible clinicians, groups, and virtual groups may qualify for a re-weighting of the Promoting Interoperability performance category to 0% if they:
- Are a small practice;
- Have decertified EHR technology;
- Have insufficient Internet connectivity;
- Face extreme and uncontrollable circumstances such as disaster, practice closure, severe financial distress, or vendor issues; or
- Lack control over the availability of CEHRT.
Note: If you’re already exempt from reporting Promoting Interoperability data, you don’t need to apply.
Who is Eligible for an Extreme and Uncontrollable Circumstances Exception?
MIPS eligible clinicians, groups, and virtual groups may qualify for a re-weighting of any or all MIPS performance categories to 0% if they are affected by extreme and uncontrollable circumstances extending beyond the Promoting Interoperability performance category. These circumstances must render them unable to:
- Collect information necessary to submit for a performance category; or
- Submit information that would be used to score a performance category for an extended period.
- Impact your normal processes, affecting your performance on cost measures and other administrative claims measures.
COVID-19 Flexibilities
For the 2020 performance year, CMS will be using the Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency. For more information, visit the QPP COVID-19 Response webpage.
How do I Apply?
New for 2020: You must have a HCQIS Access Roles and Profile (HARP) account to complete and submit an exception application on behalf of yourself, or another MIPS eligible clinician, group, or virtual group. For more information on HARP accounts, please refer to the Register for a HARP Account document in the QPP Access User Guide.
Once you register for a HARP account, sign in to qpp.cms.gov, select ‘Exceptions Applications’ on the left-hand navigation, select ‘Add New Exception,’ and select ‘Extreme and Uncontrollable Circumstances Exception’ or ‘Promoting Interoperability Hardship Exception.’
How do I Know if I’m Approved?
If you submit an application for either of the exceptions, you will be notified by email if your request was approved or denied. If approved, this will also be added to your eligibility profile on the QPP Participation Status Tool, but may not appear in the tool until the submission window is open in 2021.
For More Information
- Visit the Promoting Interoperability Hardship Exception and Extreme and Uncontrollable Circumstances Exception QPP webpages for more information and links to each application.
- Review the Exceptions Application Fact Sheet to learn more about these exceptions.
Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.