WCH Issue March 2020

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What’s new

2019 MIPS Submission Deadline Extended: Submit 2019 Data by April 30, 2020

The Merit-Based Incentive Payment System has extended its data submission deadline to April 30, 2020. Read along to find out more details regarding the deadline extension.

2019 MIPS Automatic Extreme and Uncontrollable Circumstances Policy Update

MIPS-qualified clinicians who aren’t able to submit data by April 30, 2020, will be automatically identified and receive a neutral payment adjustment for the 2021 MIPS payment year. To know more details about the policy update regarding payment adjustment, read more.

METROPLUS suspends ALL authorization requirements

MetroPlus will suspend all its authorization requirements except for Pharmacy, Dental, and DMEPOS services until April 20, 2020. It is in response to the COVID-19 pandemic, as laid out in the NYS Department of Financial Services Insurance Circular letter. Read on for more details.

Transition of Care for WellCare Member Moving to Fidelis Care

Effective June 2020, WellCare members’ health coverage will start to be issued by Fidelis Care. Read on for more details regarding the coverage transition.

Fidelis Care Authorization Grids Effective April 1, 2020

There will be a few changes in the authorization grids of Fidelis Care effective April 2020. Know more about the changes in the relevant sections by reading along.

Anthem acquires Beacon Health Options

Beacon Health Options will now start to operate as a subsidiary of Anthem after its recent acquisition of the behavioral health organization. Read more to know how it may affect you as a provider.

Referrals no longer required for in-network specialists

Effective March 28, 2020, Primary Care Providers (PCPs) will no longer need to provide referrals for in-network specialist services. As a reminder, Horizon NJ Health members must use in-network doctors and health care providers for all services.

Medicare Acupuncture for Chronic Low Back Pain to be covered by Medicare for dates of service on and after January 21, 2020.

The changes will be implemented in April 2020.

From ASH to AIM: Empire BlueCross’ Medicare Advantage Outpatient Rehabilitation Program Transition Information

Effective April 1, 2020, Empire BlueCross (Empire) will transition the utilization management of Medicare Advantage Outpatient Rehabilitation Program from American Specialty Health (ASH) to AIM Specialty Health® (AIM). AIM is a specialty health benefits company. The Outpatient Rehabilitation Program includes physical, occupational, and speech therapy services. Empire has an existing relationship with AIM in the administration of other programs.

Medical Policy Revision: Intraoperative Neurophysiologic Monitoring, Electromyography and Nerve Conduction Studies.

Effective May 7, 2020, Horizon BCBSNJ will change consideration of certain professional claims based on revisions to medical policies: Electromyography and Nerve Conduction Studies and Intraoperative Neurophysiologic Monitoring.

Business Corner

Streamlining Healthcare Provision: How to Effectively Grow Your Practice Through Efficient Services

The best way to attract patients is to show just how efficient your mode of treatment is. Find out how Dr. Potash was able to grow her practice by streamlining health provision as you read along.

Information For Providers

Use proper ICD-10 codes for COVID-19 as it affects cost-sharing that is being applied!

CMS Released Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response

Telehealth expansion during the COVID-19 outbreak. What you need to know.

Now more than ever, healthcare providers need to be efficient and effective when it comes to rendering services to their clients. Having productivity tools like the Insurance Eligibility Verification tool and the Time Management tool is instrumental in doing so. Find out how these tools can help your practice by reading more.

WCH Accomplishments

Monitor Your Claims Performance with iSmart EHR’s Dashboard

To help generate reports and assist your data analytics, iSmart EHR has added new featured data on its dashboard. Read along to find out what essential data are featured on the improved dashboard.

Your Questions Answered

If phone communication with a patient was less than 5 minutes, can we still bill 99441?

If a Medicare patient does not have Skype or another audio-video app, and Doctor spends more than 10 minutes on the call with the patient, can we bill a regular E&M service?

The provider received multiple calls from a patient during the day. How to properly code and bill Medicare for the multiple telephone communications with the same patient during a day?

Considering the latest updates, are the Physical therapists, Occupational therapists, Speech-Language pathologists eligible to perform and get paid for telehealth services furnished to Medicare beneficiaries?

We're mostly closed. I have a few scheduled post-op and emergency visits scheduled for tomorrow. I anticipate more of the same next week, perhaps going in 1-2 days next week. What am I supposed to do for my staff - I have 8 employees. Any advice is appreciated.