News to Note – February 2021

• Former Health and Human Services Secretary, Alex Azar, announced in early January that he signed another 90-day extension to the Public Health Emergency so it is now in effect until about April 20th. 
• This means all of the waivers remain in place, including the need for a three-day inpatient admission to access Part A Skilled Nursing Facility (SNF) benefits. 
• However, SNFs are free to do what they want and can refuse patients without a three-day inpatient stay. 
• The Centers for Medicare and Medicaid Services (CMS) are proposing (via posting the notice as an Agency Information Collection Notice) to roll out a program where Inpatient Rehabilitation Facilities (IRFs) must send their medical record in full to the Medicare Administrative Contractor (MAC) for approval prior to submitting the claim for payment. A couple notes:
• First, the stated purpose of this program is to reduce fraud. Not reduce improper payments, but reduce fraud. 
• Second, if an IRF does not send in their records prior to claim submission, then the MAC is instructed to request and review the record prior to processing the claim. There is no penalty for not doing it. 
• Third, if an IRF gets nine out of 10 claims approved on review, then the review process ceases, with only a 5% claim spot check. We anticipate most IRFs will hit 10 Medicare admissions pretty quickly. 
• If you are interested in this or want to comment, go to regulations.gov and search for CMS-10765. 
• Health and Human Services has removed the need for special training and a special license for physicians to prescribe the medication buprenorphine to treat opioid use disorder
• CMS has eliminated their national email distribution list for MLN Matters, the updates they produce whenever anything changes. They are instructing each person to sign up for the email distribution list for their respective MAC to get the MLN Matters. 
• If your hospital bills for outpatient clinic visits with G0463, know that CMS just announced that they are going to start recouping 30% of the payment for every line item paid for that code in calendar year 2019 now that their payment reduction has been upheld by the US Court of Appeals. It’s not a huge amount of money, but these days every dollar counts. 
• CMS has released the updated National Coverage Determination (NCD) for MitraClip. If you do those in your facility, you should download the NCD and be sure you are compliant. 
• The Government Accountability Office released a report on rural hospital closures and the numbers were staggering. When a community loses a hospital, the residents of that area lose not only the hospital but also access to outpatient care. The number of physicians dropped by nearly 20% and patients had to drive an average of 24 miles to access emergency care and over 44 miles to receive drug or alcohol treatment. Hopefully this government report gets Congress talking and acting. 
• CMS recently released an online version of the Inpatient pricer. If you know the DRG and your hospital provider number, you can now look up the expected payment. Just head over to webpricer.cms.gov and pick the inpatient PPS pricer. If you are an IRF and know the case mix group, you can also look up your payment. But, be aware that this is just an estimated payment. Some have already found errors but it is closed to corrections.