HHS Announces $20B in New Phase 3 Provider Relief Funding
October 1, 2020
The Department of Health and Human Services (HHS) announced $20 billion in new funding for providers on the frontlines of the coronavirus pandemic through Phase 3 General Distribution allocation. HHS stated that providers who received Provider Relief Fund payments can apply for additional funding, as well as previously ineligible providers, such as “those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.”
HHS stated that 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 Secretary Alex Azar stated, “HHS has worked to ensure that all American healthcare providers receive support from the Provider Relief Fund in a fast and fair way, and this new round helps ensure that we are reaching America’s essential behavioral health providers and takes into account losses and expenses relating to coronavirus.”
Additional Details on Eligibility – HHS states that it is “making a large number of providers eligible for Phase 3 General Distribution funding, including:
• Providers who previously received, rejected or accepted a General Distribution Provider Relief Fund payment. Providers that have already received payments of approximately 2% of annual revenue from patient care may submit more information to become eligible for an additional payment.
• Behavioral Health providers, including those that previously received funding and new providers.
• Healthcare providers that began practicing January 1, 2020 through March 31, 2020. This includes Medicare, Medicaid, CHIP, dentists, assisted living facilities and behavioral health providers.”
Providers may apply for funding from October 5, 2020 through November 6, 2020.
Additional information can be found in the HHS press release.
Trump Signs Short-term Gov’t Funding Bill that Alters Medicare Loan Repayment
by Robert King | October 1, 2020
President Trump signed into law late Wednesday a short-term government funding bill that includes changes to repayment terms for certain providers for COVID-19 loans.
The continuing resolution, which funds the government through Dec. 11, includes new deadlines for participants to repay loans from the Medicare Advance and Accelerated Payments program. The program enabled hospitals and certain providers in Part A and suppliers in Part B to get advance loans to cover major financial hits caused by the pandemic.
“Medicare accelerated and advanced payments have been a lifeline to many hospitals and health systems in the fight against this historic pandemic, allowing them to continue to deliver the care that their patients and communities depend on,” said American Hospital Association President and CEO Rick Pollack in a statement after Congress passed the bill on Wednesday.
CMS had doled out more than $100 billion in advance loans to providers at the onset of the pandemic. The agency suspended the program in April.
But the loans started to become due starting on Aug. 1. CMS could garnish Medicare payments to such providers to repay the loans.
Trump’s Surprise Billing Order Calls for Naming and Shaming Aggressive Billers
By Michael Brady | September 25, 2020
President Donald Trump’s executive order on surprise billing directs HHS to update the Hospital Compare website within six months to inform Medicare beneficiaries about hospital billing practices, but experts said it would take far longer to go into effect.
The information would include whether a hospital follows price transparency rules and gives patients an itemized list of the services they received at discharge. It would also tell consumers how often a hospital sues its patients over billing issues, including whether a hospital tries to garnish a patient’s wages, places a lien on their home or withdraws money from a patient’s income taxes.
It’s an effort to name and shame providers for their aggressive billing practices, said John Barkett, senior director of policy affairs at Willis Towers Watson.
Surprise billing is the biggest outstanding healthcare issue for American consumers and businesses, said Cynthia Fisher, founder of Patient Rights Advocate, a group that supports healthcare transparency.
“Everyday people are having highway robbery committed against them,” she said.
Reforming balance billing is part of the Trump administration’s broader attempt to increase market competition and consumer choice in healthcare through system-wide transparency and data portability. But hospitals don’t want it because they “like the competitive barriers that exist today,” Fisher said. She thinks giving consumers more information about hospitals’ billing practices would increase consumer choice and competition among providers.
The executive order is a sign that the Jan. 1 deadline for hospitals to meet the administration’s price transparency requirements is here to stay, said Carol Skenes, manager of advisory services for nThrive, a revenue cycle management company. Many healthcare industry executives hope HHS will extend the deadline for hospitals to follow the new rules, given the challenges posed by COVID-19 and creating a machine-readable data file. But hospitals that are “rolling the dice for an extension” should prepare to meet the Jan. 1 deadline, Skenes said.
It’s unlikely hospitals and the administration could meet Trump’s six-month timeline for making all the changes, experts said. HHS would only have three months to check whether hospitals were following the price transparency rules. It would also need to collect data about legal actions and what information hospitals give to patients when they discharge them. That could be difficult because many practices aren’t standardized or tracked consistently. For example, hospitals might have to dig through legal documents to figure out exactly what actions they’ve taken against patients over billing issues.
To read more, go to Modern Healthcare.
Offering Imaging Exam for Free Ups Utilization by 546%, with Key Gains in Underserved Populations
By Marty Stempniak | September 23, 2020
Offering CT coronary artery calcium screening at no cost led to a 546% average monthly increase in the use of the test, experts reportedly recently.
Providers typically use such scans to help predict a patient’s risk of heart attack, stroke or cardiovascular death. But CAC screening can cost between $400 and $800, with insurers typically not covering the exam, noted experts with University Hospitals Health System in Cleveland.
Wanting to boost the use of this “crucial” screening tool, the Ohio institution in 2017 started offering coronary artery calcium tests for free. And it’s logged impressive numbers a few years in, with key gains among women, minorities and patients from lower-income ZIP codes, researchers reported in the Journal of the American College of Cardiology.
“This study shows what we hoped would be the case: More patients undergo testing when that testing comes at no cost to them,” study co-author Sanjay Rajagopalan, MD, chief of cardiovascular medicine at UH Cleveland Medical Center, said Monday. “The fact that more people, especially women and socioeconomically disadvantaged segments, utilize this test at no cost is very meaningful,” he added.
To reach their conclusions, Rajagopalan and colleagues analyzed data from 27,466 patients treated across 21 radiology locations in Northeast Ohio. Those included 5,109 treated during the initial phase when University Hospitals only charged $99 for a CAC test and another 22,357 who paid nothing for the imaging exam.
Along with the fivefold surge in visits, the health system also saw increases in the age of patients treated from (from 57.9 up to 59.3), women (from 46% to 51%), and Black patients (7.2% up to 9.4% following the price elimination). Plus, the intervention also contributed to reclassification of statin eligibility, changes in preventive medications, and improvement to risk factors, the authors noted.
“Making this screening no-cost improves access for everyone, but especially minorities and those with lower incomes,” Dan Simon, MD, University Hospital’s chief clinical and scientific officer, said in a statement.
Will Medicare Reimbursement Propel Radiology AI Market?
The decision by the U.S. Centers for Medicare and Medicaid Services’ (CMS) earlier this month to provide its first-ever reimbursement of a radiology artificial intelligence (AI) algorithm was a significant milestone for the industry, raising hopes that it could set the groundwork for broader coverage of imaging AI software.
Effective for a three-year period beginning in the 2021 fiscal year, CMS has granted new technology add-on payment (NTAP) status for use of Viz.ai’s ContaCT (Viz LVO) AI algorithm, which analyzes CT angiography (CTA) exams after acquisition and alerts an institution’s stroke specialist team if it detects a large vessel occlusion (LVO) stroke.
For Viz.ai, the NTAP award was the culmination of a two-year process that involved several clinical studies, numerous conversations with CMS on the research data, and support from a number of societies, advocacy organizations, and leading stroke researchers, according to co-founder and CEO Dr. Chris Mansi.
NTAPs are granted by CMS for new and high-priced technologies that provide a substantial clinical benefit and aren’t currently covered under a Medicare Severity-Diagnosis Related Group (MS-DRG). In their clinical studies, Viz.ai was able to demonstrate that the technology provided time savings, improved outcomes, and increased access to care, Mansi said.
Under the NTAP, CMS will now reimburse 65% of the estimated loss for a hospital — up to $1,040 per patient — for Medicare patients with suspected stroke who have been analyzed by the firm’s Viz LVO algorithm and whose estimated costs to use the software exceed the DRG.
The company estimates about half of the Medicare patients with suspected ischemic stroke patients who receive Viz LVO analysis will qualify for payment. There is no maximum annual payout cap for an institution. Importantly, the standard radiology interpretation of the CT scans is not affected by the NTAP; the payment is an add-on for the DRG.
To read more, go to Aunt Minnie.