Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to 3 rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate.
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As COVID-19 vaccines continue rolling out across the country, the Centers for Medicare and Medicaid (CMS) is taking action to protect the health and safety of patients and providers and providing updates on the latest COVID-19 resources from the Department of Health and Human Services (HHS), the Centers for Disease Control and Preventions (CDC), and CMS.
The next CMS Physicians, Nurses and Allied Health Professionals Open Door Forum is scheduled for Wednesday, April 14, 2021 from 2:00 – 3:00 PM (ET). The call will provide updates on the following:
Open Payments Pre-publication Review and Dispute Reminder
Primary Care First: Second Cohort Application
To participate by phone:
The Health and Human Services (HHS) Office of Minority Health has partnered with the Centers for Medicare & Medicaid Services (CMS) and other HHS agencies to identify and compile multilingual resources and materials for Medicare providers to assist them in providing culturally and linguistically appropriate services. Translated resources include materials and information regarding specific diseases and conditions, health insurance, women's health topics, substance use, emergency preparedness and response, and more.
On March 15, CMS is increasing the Medicare payment amount for administering the COVID-19 vaccine. This new and higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education, and hiring additional staff. At a time when vaccine supply is growing, CMS is supporting provider efforts to expand capacity and ensure that all Americans can be vaccinated against COVID-19 as soon as possible.
The data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2020 performance year of the Quality Payment Program (QPP) ends at 8:00 PM (ET) on March 31, 2021.
CMS announced it will hold physicians harmless from Merit-based Incentive Payment System (MIPS) penalties due to the significant disruptions the COVID-19 public health emergency placed on physician practices’ performance in 2020.
The Extreme and Uncontrollable Circumstances Hardship Exception policy will be automatically applied to MIPS eligible clinicians who do not submit any MIPS data for the 2020 performance period; these clinicians will avoid a payment penalty in 2022.
Consultations, Hospital Inpatient Services, Hospital Observation Services
As of January 1, 2021, CPT codes 99202-99215 should be selected either based on time or medical decision making. However, the new guidelines do not apply to other E/M services such as consultations, hospital inpatient services, and hospital observation services. Be sure to review the new guidelines in the AMA CPT® Professional Edition manual.
Prolonged Services