ACP continues to advocate for pay parity for telephone visits
May 1, 2020 (ACP) – The Centers for Medicare & Medicaid Services (CMS) will now pay 100 percent of the Medicare rate to physicians who have provided testing or treatment for uninsured patients with COVID-19. These funds will come from the recently replenished Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund, which provides monies to hospitals, physicians and other health care entities to help them withstand some of the financial hardships associated with the pandemic.
“This is good news, and we advocated for it specifically,” said Shari Erickson, vice president for governmental affairs and medical practice at the American College of Physicians. This payment is retroactive and applies to testing and treatment starting Feb. 4, 2020. Claim submissions will begin in early May 2020, Erickson said.
This win is among many of the policy changes that ACP has been working toward to help practices cope with COVID-19. The CARES Act will also distribute a second portion of $20 billion. Unlike the first round of $30 billion in payments, these monies are loans and recipients will need to pay them back, Erickson noted. This round of payments will also require submission of 2018 Medicare revenue data. Those hospitals and facilities that have already submitted cost reports to CMS will receive these loans automatically, and those without adequate data on file will need to submit their revenue information through a portal. “This will include physician practices, not just hospitals and facilities,” Erickson said. The portal is available at https://covid19.linkhealth.com/#/step/1
What's more, the CARES Act, which initially distributed $100 billion for hospitals including the $50 billion for Medicare-eligible facilities and clinicians, now has an additional $75 billion to distribute, Erickson said. “There are now additional provider relief funds, and we will be advocating for the best ways to distribute these newly added funds,” she said.
This $75 billion is in addition to the $320 billion that will replenish the Paycheck Protection Program (PPP). “There is new legislation that is being called Stimulus 3.5 with additional funds for programs including the PPP,” Erickson said. She advises members to check on the status of their small business association loan applications and/or submit an application now because more funds are available.
Earlier this week ACP sent a letter to the U.S. Department of Health and Human Services (HHS) noting that physician practices need to be prioritized when distributing these funds. The letter recommended that the funds be distributed using a per-patient, per-month payment. Noting problems that fee-for-service payments have posed for practices when they have been trying to operate during the COVID-19 national emergency, ACP called attention to existing Medicare programs operating under the Center for Medicare and Medicaid Innovation that already use this type of payment for primary care physicians.
“COVID-19 has illustrated the flaws of paying primary care physicians predominantly on a fee-for-service basis, because as they have moved away from in-person visits, they no longer are getting the ‘fee’ associated with the office visit service, while the ‘fees' for telehealth and audio-only phone calls have not been sufficient to offset the loss of revenue from in-person visits,” noted Dr. Jacqueline Fincher, president of ACP, in the letter to HHS Secretary Alex Azar. “Distributing funds to primary care physicians and their practices through a per patient, per month methodology would provide them with the revenue and support needed to keep their practices open at this difficult time, without having to depend on a flawed fee-for-service system that is unlikely to provide them the support needed and make them whole for lost revenue.”
Pay Parity for Telephone Visits
ACP has been aggressively lobbying CMS for pay parity for telephone visits. “There has not been an announcement yet, but we are hoping that it is coming,” Erickson said. Physicians are currently paid significantly less for telephone visits than for video or in-person visits. “Not reimbursing for telephone visits will disproportionally affect physicians and practices taking care of elderly and underserved patients who don't have access to video conferencing services,” she said. “Physicians' doors can't stay open if they can't provide care and get paid.”
Because coverage during the COVID-19 pandemic has been an evolving target, Erickson noted that ACP is maintaining an updated webpage to help members stay abreast of any and all changes to payer policies. This webpage details basic information from all of the major insurance plans. “Some payers state whether they are reimbursing for audio-only visits at the same rate as in-person visits,” Erickson said. “At a high level, most payers are following CMS policies and updating their own accordingly.”
The ACP site also links out to external resources that point to state-by-state polices. For example, the Alliance for Connected Care offers a chart depicting state changes to licensure, coverage and other changes. “Members should visit our resource center regularly for up-to-date information on changes in payer policy or federal relief programs,” Erickson said.
Up-to-date practice management resources during the COVID-19 pandemic are available on the ACP website.
Back to the May 1, 2020 issue of ACP Advocate