CMS Announces Major New Flexibilities for Physicians During COVID-19 Emergency

Members & Publications

March 31, 2020

On March 30, the Centers for Medicare & Medicaid Services (CMS) announced a number of new policies to help physicians and hospitals during the COVID-19 pandemic.

AAPM&R is currently undergoing an in-depth review of these materials, but we can share important updates with you below. As we take a closer look at the materials from CMS, we will share additional information with you and will continually update our COVID-19 Member Support and Resource Center.

  • Local private practice clinicians and their trained staff may take temporary employment at hospitals and health care systems while they are not performing nonessential services.
  • CMS has expanded the list of services physicians can provide via telehealth during this public health emergency. Additionally, for telehealth visits on the Medicare telehealth services list provided with audio and visual equipment permitting two-way real-time interactive communication can be reimbursed the same as a face-to-face visit. CMS also indicated it will reimburse for telephone visits (CPT codes 98966-98968 and 99441-99443). Find a summary of the physician and provider specific items here.
  • CMS issued several emergency declaration blanket waivers for health care providers, which includes the following provision:
    • Flexibility for Inpatient Rehabilitation Facilities Regarding the “60 Percent Rule” – CMS is allowing IRFs to exclude patients from the freestanding hospital’s or excluded distinct part unit’s inpatient population for purposes of calculating the applicable thresholds associated with the requirements to receive payment as an IRF (commonly referred to as the “60 percent rule”) if an IRF admits a patient solely to respond to the emergency and the patient’s medical record properly identifies the patient as such. In addition, during the applicable waiver time period, we would also apply the exception to facilities not yet classified as IRFs, but that are attempting to obtain classification as an IRF.
  • Other flexibilities for inpatient rehabilitation facilities in the fight against COVID-19 include, but are not limited to:
    • Use of telehealth to fulfill the face-to face physician visits at least three days a week
    • Waiver of the Post-Admission Physician Evaluation
  • CMS released COVID-19 provider burden relief FAQs, including information regarding eliminating paperwork requirements to allow clinicians to focus on patients:
    • Q. Is CMS suspending most Medicare Fee-For-Service (FFS) medical review during the Public Health Emergency (PHE) period for the COVID-19 pandemic?
      A. Yes, CMS has suspended most Medicare Fee-For-Service (FFS) medical review during the emergency period due to the COVID-19 pandemic. This includes pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program, and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC). No additional documentation requests will be issued for the duration of the PHE for the COVID-19 pandemic. Targeted Probe and Educate reviews that are in process will be suspended and claims will be released and paid. Current post-payment MAC, SMRC, and RAC reviews will be suspended and released from review. This suspension of medical review activities is for the duration of the PHE. However, CMS may conduct medical reviews during or after the PHE if there is an indication of potential fraud.


Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.