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Trump Administration Encourages Reopening of Healthcare Facilities | Record spikes in new coronavirus cases, hospitalisations sweep parts of US | WHO chief warns of a ‘resurgence’ as over 100,000 cases have been reported worldwide each day over the past two weeks | AMA – Doctors To Work To End Police Brutality, Racism In Healthcare| CMS warns nursing homes against seizing residents’ stimulus checks|

Recent Posts

UHC Extensions of Existing Prior Authorizations

15 Jun, 2020 - 11:07 pm

The following prior authorization provisions apply to all Individual and Group Market health plans, and Medicaid and Medicare Advantage plans. A 90-day extension, based on original authorization date, of open and approved prior authorizations with an end date or date of service between March 24, 2020 and May 31, 2020, for services at any care […]


A Permanent Policy Solution on Telehealth for Therapy

15 Jun, 2020 - 10:58 pm

ome major advocacy pushes for the profession are getting attention: A bipartisan bill introduced into the U.S. House of Representatives targets several big legislative issues being worked on by APTA, including a proposed severe cut to Medicare payments and permanent continuation of physical therapy delivered via telehealth. If adopted and signed into law, the legislation […]


EPC letter May 14,2020 – Resubmission of Claims for COVID-19 HCPCS and CPT Codes

15 Jun, 2020 - 10:50 pm

The Department of Health Care Services (DHCS) identified a claims processing issue affecting claims for Covid-19 HCPCS Code U0001, U0002 and CPT Code 87635. This issue caused claims to erroneously deny. The issue affected claims for dates of service from February 4, 2020, through April 9, 2020. No action is required on your part. The […]


COVID-19 May Drive More Insurers into ACA Exchanges

15 Jun, 2020 - 10:47 pm

ne recent analysis suggested that there could be “unprecedented growth” in the individual health insurance market. “The impact of COVID-19-related job losses will likely more than double the current enrollment in Individual & Marketplace plans, with the potential for the Individual market to triple in size to over 35 million in a sustained and severe […]


CMS Announces Final Payment Notice for 2021 Coverage Year

9 May, 2020 - 12:21 pm

he Centers for Medicare & Medicaid Services (CMS) today issued a final rule that continues the Trump Administration’s efforts to promote affordability, improve consumer choice, ensure program integrity, and increase market stability. In response to the coronavirus disease 2019 (COVID-19) pandemic, CMS is also announcing today a one week extension of the Qualified Health Plan (QHP) certification […]


CMS Allows PTs in Private Practice to Provide Services Via Telehealth

9 May, 2020 - 12:08 pm

The Basics Physical therapists in private practice are eligible to bill Medicare for certain services provided via telehealth. [Editor’s Note: APTA is seeking confirmation as to whether services furnished by PTAs via telehealth are eligible for reimbursement.] Services that started as of March 1, 2020, and are provided for the duration of the public health […]


CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program

29 Apr, 2020 - 7:57 pm

Today, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers […]


Second phase of stimulus money- HHS started distribution

29 Apr, 2020 - 7:51 pm

The U.S. Department of Health and Human Services (HHS) has started distribution of the next $20 billion in financial relief for physician practices, groups and other health care delivery organizations that is part of the Coronavirus Aid, Relief and Economic Security (CARES) Act. The relief comes under the Public Health and Social Services Emergency Fund […]


CMS Increases Medicare Payment for High-Production Coronavirus Lab Tests

15 Apr, 2020 - 8:38 pm

Medicare will pay the higher payment of $100 for COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results, and more effective means of combating the spread of the virus. High-throughput lab tests can process more than two hundred specimens a day using […]


New official guidance on diagnoses from telehealth services for risk adjustment

15 Apr, 2020 - 8:28 pm

CMS has already expanded their coverage on Telehealth services due to COVID-19 emergency. The memo, entitled “Applicability of diagnoses from telehealth services for risk adjustment,” explains when MA organizations and other organizations may submit diagnoses from telehealth visits for risk adjusted payment. The memo was sent to organizations on Friday but has not yet been […]