Blog and Helpful Articles

Did You Know…Medicare pays for Alcohol Mis-Use Screening & Counseling?

We all understand that mis-use of alcohol can lead to significant issues, but not many providers know that CMS will pay them to conduct a 15-minute patient screening to identify any mis-use of alcohol and, if found, to deliver up to four, brief (15 minutes each) face-to-face counseling interventions. The alcohol screening can be accomplished in various ways but one widely used mechanism is the Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization. Download a copy here. The test can be completed by the patient or the questions can be asked of the patient and recorded.

CMS’s guidelines for a positive screening are:

Under 65

Women: more than 3 drinks at a time or 7 drinks per week*
Men: more than 4 drinks at a time or 14 drinks per week*

Over 65

Men & women: more than 3 drinks at a time or 7 drinks per week*

*JAMA defines a drink as 12oz beer, 5oz wine, or 1.5oz liquor.

One screening and up to four counseling sessions, reflecting the 5As, are covered per year. Both can be delivered via telehealth (audio only) during the public health emergency.

Feel free to request our free bulletin on billing this service and be sure to check with commercial payors to see if they also cover alcohol mis-use screening and counseling.

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Tagged alcohol mis-use counseling, alcohol mis-use screening, cms, medicare, telehealth |

What We’re Reading – McKinsey Analysis: Up to $250B of Healthcare Could Be Virtualized

This article summarized an analysis of the growth in telehealth done by McKinsey & Company, which as we know, has been exponential due to the COVID-19 crisis. The article noted that providers are seeing 50 to 175 times the number of telehealth patients than prior to this escalation. It is estimated that an industry that generated approximately $3B in revenue could grow to $250B. This accounts for 20% of all Medicare, Medicaid and commercial outpatient, office and home health spending. This is seriously staggering!

The news is full of reports of patients who delayed care, some to their detriment, and the article states that 70% of in-person visits were canceled due to the COVID crisis. However, in just this short time, more than three quarters of survey respondents indicate a likelihood to use telehealth in the future and almost the same percentage reports high satisfaction. Telehealth is a win for providers as well, with 57% seeing telehealth in a more favorable light and 64% report feeling comfortable using it.

The author concludes that many of the relaxed regulations regarding telehealth could be in place for another 12 to 18 months, so this will certainly be an interesting time for the US healthcare system.

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Tagged Coronavirus, COVID-19, telehealth, virtual visits |

What We’re Reading – OSHA Return to Work Guidance

As the COVID pandemic rages on and businesses are struggling to get back to normal. What guidelines do we use to keep our employees safe and avoid mis-steps?

Here is an article that highlights the recommendations from The Occupational Safety and Health Administration (OSHA). OSHA has been proactive in issuing guidelines that address the various elements that may affect your industry. This is important as “one-size-fits-all solutions might not work for everyone”. For example, the author reminds employers that if they have to conduct temperature checks and store the readings, these may constitute medical records under OSHA and subject to stringent retention timeframes. The issue of PPE is also addressed. From time to time, we hear of companies that can’t afford to provide workers with PPE. OSHA’s guidance is very clear on this point: if PPE is needed to do the job and it is not available, the job cannot be safely done and must be discontinued.

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Tagged Coronavirus, COVID-19, employer guidance, OSHA, PPE |

Medical Practices Must Attest by June 3rd to Receive More CARES Act Funds

Medical practices that received the general allocation fund payments and who want to qualify for additional payments, must attest via portal by June 3^rd, 2020.

The requirements are two-fold:

Confirm receipt of previous funds on the CARES Act Provider Relief Fund Payment Attestation Portal, including agreeing to the Terms and Conditions. If you received payment via check, cashing or depositing the check will also be viewed as acceptance of the Terms and Conditions. Checks are valid for 90 days from date of issuance. Checks not cashed within the 90 days will be voided and considered a rejection of the funds.
Submit your revenue information to the General Distribution Portal for consideration to receive additional General Distribution funds. All providers are required under the Terms and Conditions to submit revenue information to the provider portal for later verification.

What We’re Watching – Navigating PPP Loan Forgiveness: What You Must Know

Many employers applied for and received Paycheck Protection Program (PPP) loans to help with payroll and other approved expenses. The advantage of this loan is its forgiveness aspect which can essentially transform it into a grant. Over the last two months, there have been many changes and tweaks to the PPP’s guidelines and for some companies, the eight-week period for using the funds is drawing to a close.

We viewed (several times, actually!) this excellent webinar from McDermott Will & Emery, which summarizes the current process for applying for PPP loan forgiveness. One big change occurred in the definition of full-time equivalents (FTE). Initially, the PPP considered an FTE someone who worked 32 hours per week; this has now changed to 40 hours per week. The change can affect the percentage of your loan’s forgiveness. Speaking of which, one good change is the ability to prorate the amount forgiven. So if an employer spends less than 75% of the funds on payroll and approved expenses, it can at least request forgiveness of some of the proceeds.

There is additional information on time periods, accrued vs. paid payroll expenses, and the documentation needed for forgiveness, so this webinar is truly a ‘must-see.’ You can access the forgiveness application here.

Update: On June 5, 2020, President Trump signed the PPPFA which changed some of the information in this blog. We suggest reading our blog that explains the PPPFA changes.

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Tagged FTE, full-time equivalent, PPP guidelines, PPP loan, PPP loan forgiveness |

Telehealth & MRA

There is much miscommunication regarding the use of telehealth services to report risk adjusted diagnoses. In the early days of COVID-19, CMS stated that it would pay for telehealth services that were conducted in an interactive format using both audio and video telecommunications. When issues regarding seniors’ (and providers’) lack of access to real-time video calls were escalated, CMS relaxed the standard for telehealth visits to only audio (such as a telephone call). However, this is for fee-for-service Medicare visits.

The standard for risk adjustment (MRA) is still a face-to-face visit, and due to the public health emergency, now includes telehealth via interactive audio AND video. This must be clearly documented on the note and coded with either place of service code “02” or modifier “95.” A telehealth visit using only audio may be payable by CMS for a Medicare beneficiary, but this visit will not count for logging MRA diagnoses for Medicare Advantage patients and ACOs.

Providers must document that the patient gave consent to the telehealth (audio/video) visit.

Attached is a memo from CMS for your records.

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Tagged cms, mra, risk adjusted reimbursement, risk adjustment, telehealth |

ESRD Patients Can Join Medicare Advantage Plans in 2021

As we may know, patients with end stage renal disease (ESRD) have, historically, not been allowed to enroll in Medicare Advantage plans. About 130,000 were grandfathered in through employer-sponsored coverage or developed it after enrolling in MA plans. That will change for 2021. The 21^st Century Cures Act changed policy that allows ESRD patient MA Plan enrollment, and CMS estimates an additional 83,000 will sign up by 2026.

While this is undoubtedly good news for ESRD patients, the same sentiment doesn’t necessarily carry through to MA plans or risk-based providers. America’s Health Insurance Plans (AHIP), a trade organization for insurers, reports a medical loss ratio of 112% for ESRD patients in MA plans. The medical loss ratio is the percentage of the premium dollars spent on medical benefits, and is mandated by the PPACA to be at least 85%.

Some bright spots in this change for MA plans and providers are a carve out of the kidney acquisition costs for transplants; those will be paid by the Medicare program. Additionally, there is a proposal to allow MA plans more flexibility in managing their networks to reduce dialysis expenses.

This handy fact sheet from AHIP summarizes the policy change.

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Tagged dialysis, end stage renal disease, ESRD, kidney disease, MA plans, medicare advantage, mra |

What We’re Reading – How to deal with micromanagers in a COVID-19 world

The effects of the Covid-19 pandemic go beyond a global medical crisis to exacerbate the insecurities and control needs of micromanagers, which leads to added work tension and employee dissatisfaction during such a stressful time. The author of this article points out how the new challenges of keeping a successful and functional business as we enter one more month of quarantine have triggered some bosses’ micromanaging traits. Fortunately, the article also enumerates some good practices for employees to deal with a controlling boss.

Communication between employees and managers is critical in the new working conditions generated by the COVID-19 pandemic. Micromanagers often get lost in the big picture and forget to provide clear deadlines and directions for their subordinates to follow. Consequently, employees would benefit from asking their supervisors to provide a clear set of priorities, which not only helps the employee achieve his daily goals in the most beneficial way for the company but helps to build trust and reduce the need for micromanagement.

After establishing a set of priorities, different apps and online platforms, such as Slack, Zoom, Trello, and Google Docs, are convenient technological vehicles to facilitate the communication between managers and employees. However, the author of this article stresses the potential benefits of asynchronous communication to allow more flexibility in the remote work environment. Not all meetings need to be live meetings; employees and managers can record their messages at different points of their day depending on their availability.

In addition to setting priorities and using technology, the article suggests that employees document all the processes, practice empathy, and bring any micromanagement issues up to the manager’s attention since she might not be aware of her behavior. COVID-19 has brought new challenges for employees and managers; therefore, joining forces is the best approach to reducing the controlling needs of micromanagers and creating a better work environment.

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Tagged asynchronous communication, communication, COVID-19, employee documentation, employee priorities, micromanagement, pandemic |

What We’re Reading – How to Successfully Manage Remote Employees

In the current era of expanded remote work, this article is very timely, and the author asserts that businesses can not only survive under this arrangement, but they can thrive if the process is managed correctly. COVID-19 has driven much of the expansion of remote work, but in some cases, it may be very cost effective for employers to consider switching some or all face-to-face (F2F) employment to remote work.

Some benefits to employers and employees can be less distractions during the work-day, time savings the employee can devote to personal pursuits for greater work/life balance, and more scheduling flexibility. Both parties can also realize cost savings: employees can save on wardrobe, commuting and even lunch costs, while employers can save on space and other overhead expenses.

The article explained that managers need to be mindful of two challenges: employees feeling disconnected due to less interaction with others, and employees who need extra attention and may lack the added support and structure from a F2F workplace. In both cases communication and attention are key. The article explored various forms of communication and best practices to maintain the connection with remote workers, and the author cautioned against “death by meeting.”

As managers, we need to set clear expectations and reasonable deadlines, taking into consideration, for example, that these may be affected by other family members being home during the C-19 crisis, no available child care, inadequate work space in the home, etc. The last two points were reminders that remote employees have the same rights as F2F workers to be free from discrimination, have employment policies applied uniformly, and to a safe work environment.

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Tagged Coronavirus, COVID-19, remote workers, work from home |