Yeo & Yeo Medical Billing & Consulting is pleased to announce that Eva Rudich has earned the Certified Professional Compliance Officer (CPCO®) Credential. The CPCO credential recognizes Rudich’s knowledge of healthcare compliance, including internal compliance reviews, audits, risk assessments, and staff education and training.
The CPCO designation is awarded to medical billing professionals who, through rigorous examination and experience, have a proven knowledge to effectively develop, implement, and monitor healthcare compliance programs. To earn the credential, Rudich passed a comprehensive exam covering topics including daily operational aspects of compliance programs, key laws and regulations, and policies used to address potential fraud and abuse, including associated penalties and fines.
“Earning the CPCO credential is a tremendous accomplishment,” said Kati Krueger, President of Yeo & Yeo Medical Billing & Consulting. “Eva’s increased knowledge of healthcare compliance will continue to benefit clients and YYMBC, ensuring accuracy in billing, reducing risks, and maintaining the highest ethical standards.”
Rudich is a medical biller and account manager with more than 32 years of medical billing and coding experience. She also holds the Certified Billing & Coding Specialist (CBCS) credential and the Certified Professional Coder (CPC®) credential. Her areas of specialization include managing accounts for internal medicine, family practices, hospitalist groups, and gastroenterology. She is a member of the American Academy of Professional Coders and the National Healthcare Association.
Rudich said that continuing education is invaluable when it comes to serving clients. “Rules and laws change regularly, especially in healthcare. While I have become quite familiar with healthcare compliance through the years, earning this credential has given me even more knowledge that I can use to assist and educate providers and their staff.”
The Centers for Medicare & Medicaid Services (CMS) released the final 2024 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) participation options and requirements for 2024. The final rule:
- Sets the 2024 Medicare payment rates for physician services. For 2024, CMS finalized a conversion factor of $32.7442 and $20.4349 for Anesthesia (a decrease of -3.4% and -3.3%, respectively, from final 2023 rates);
- Implements E/M add-on code G2211 and defines the “substantive portion” of a split (or shared) E/M visit to mean more than half of the total time spent by the physician or nonphysician practitioner or a substantive part of the medical decision making;
- Reimburses telehealth services furnished to patients in their homes at the typically higher, non-facility PFS rate;
- Allows direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024;
- Continues coverage and payment of telehealth services included on the Medicare Telehealth Services List through 2024;
- Pauses implementation and rescinds the Appropriate Use Criteria program regulations;
- Maintains the performance threshold of 75 points for all three MIPS reporting options;
- Adds five new MIPS Value Pathways related to women’s health, prevention and treatment of infectious disease, quality care in mental health/substance use disorder, quality care for ear, nose, and throat, and rehabilitative support for musculoskeletal care;
- Makes numerous changes to the Medicare Shared Savings Program (MSSP) such as revising the MSSP quality performance standard, modifying the program’s benchmarking methodology, and determining beneficiary assignment under the MSSP; and,
- Ends the 3.5% APM Incentive Payment after the 2023 performance year/2025 payment year, and transitions to a Qualifying APM Conversion Factor in the 2024 performance year/2026 payment year.
The calendar year 2024 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better access to care, quality and affordability.
Yeo & Yeo Medical Billing & Consulting (YYMBC) proudly marks a significant milestone, celebrating 25 years of dedicated service and innovation in medical billing and practice management. Established in 1998, the company has evolved into a trusted partner, supporting physicians, group practices, and healthcare organizations throughout Michigan in achieving operational excellence.
A legacy of growth
Yeo & Yeo Medical Billing & Consulting has roots dating back more than 100 years when Yeo & Yeo CPAs began serving the healthcare industry in Saginaw, Michigan. In 1998, Affiliated Medical Billing, as it was known then, started with a small team and quickly grew with a focus on streamlining physician practices and enhancing business functions.
In 2017, Kati Krueger became president of YYMBC. With her leadership, the company has embraced technological advancements, implementing cutting-edge solutions like robotic process automation, ensuring efficient operations and enhanced client experiences.
“Embracing the latest technologies is pivotal in our commitment to providing exceptional service,” said Krueger. “Applying these technologies, we enhance accuracy, streamline processes, and empower our team to help our clients thrive.”
Denise Garrett, billing manager at YYMBC, emphasized how technology has transformed their services, stating, “With today’s web-based connectivity, our clients can see every outstanding claim. It is more transparent now for the client and gives them peace of mind that everything is working as it should.”
A testament to excellence
YYMBC stands apart with its commitment to staying ahead of industry changes, providing specialized knowledge in coding, compliance, medical audits, and practice management. Their consultative services, combined with offerings from Yeo & Yeo CPAs & Advisors and Yeo & Yeo Technology, present comprehensive solutions for healthcare professionals, ensuring efficiency and compliance.
Krueger said, “We have a great team of medical billers who work hard and strive to get the maximum reimbursement for our clients. We continually educate our staff so they know the ever-changing policies and rules. We remain committed to growth and constantly evolving our service offerings to meet the changing needs of the healthcare landscape.”
Traci Cook, account manager at YYMBC, added, “There is a sense of security and support because you have a team of people available who have specializations in multiple areas, especially now that billing is more complicated than ever.”
A bright future ahead
As Yeo & Yeo Medical Billing & Consulting’s professionals celebrate this remarkable 25-year journey, they express their gratitude to all past and present clients and colleagues for their trust and collaboration.
“We want to create the best experience for our clients and our people,” Krueger said. “Our success wouldn’t be possible without their continued trust and hard work. We are proud to celebrate this milestone and excited for the opportunities the future holds.”
For more information about Yeo & Yeo Medical Billing & Consulting and its services, please visit www.yeoandyeomedicalbilling.com.
Yeo & Yeo Medical Billing & Consulting is pleased to announce that Denise Garrett has earned the Certified Professional Biller (CPB®) Credential. The CPB credential recognizes Garrett’s knowledge in maintaining all aspects of the revenue cycle, particularly patient and payer billing and collections.
The CPB designation is awarded to medical billing professionals who, through rigorous examination and experience, have proven knowledge of submitting claims compliant with government regulations and private payer policies. CPBs are expected to follow up on claim statuses, resolve claim denials, submit appeals, post payments and adjustments, and manage collections. To earn the credential, Garrett passed a comprehensive exam covering topics including the application of payer policies, compliance rules, healthcare regulations, CPT® procedure codes, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes.
“Denise is a distinguished member of our team,” said Yeo & Yeo Medical Billing & Consulting President Kati Krueger. “Earning the CPB credential is an accomplishment that underscores her unwavering dedication, extensive knowledge, and the multitude of credentials she has acquired over the years to help better serve our clients. Her passion for her work and her drive to improve her skills continue to set her apart as a leader in her field.”
Garrett is a billing manager with more than 20 years of medical billing and coding experience. She holds many credentials, including the Certified Professional Coder (CPC), Certified Physician Practice Manager (CPPM®), Certified Professional Compliance Officer (CPCO™), Certified Professional Medical Auditor (CPMA®), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), and Certified General Surgery Coder (CGSC). Her areas of specialization include coding diagnoses, services, and procedures for physician practices, as well as meeting the business needs of healthcare entities through finding operational efficiencies, staff training, and technology solutions. Garrett serves on the national board of directors of the American Academy of Professional Coders Chapter Association (AAPCCA). She is also a member of the National Alliance of Medical Auditing Specialists.
Garrett said that continuous learning and earning credentials like the CBP have helped her elevate the level of service she can provide to clients. “I continue to stay current with new developments in medical billing and gain knowledge in all areas of revenue cycle management, so I am armed with the tools necessary to help our healthcare clients succeed.”
As of April 10th, 2023, the Biden Administration has announced that the end of the Public Health Emergency (PHE) Covid-19 will be on May 11th ,2023. Included in the end of the PHE, the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) has stated that the Notifications of HIPAA Enforcement Discretion will also end on My 11th, 2023. Previously, the Administration guaranteed a 90-day warning for providers to come into compliance to HIPAA rules relating to telehealth services. This 90-day grace period is meant to help avoid “creat[ing] wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans,” (HHS Press Office). OCR said it would continue to exercise its enforcement discretion and not impose penalties on covered providers for noncompliance during the 90- day transition period, ending on August 9th,2023.
During the public health emergency, providers did not have to be licensed in the state where the patient was located, they were allowed to treat patients in other states via telecommunication. Under the PHE, non-HIPAA compliant platforms were allowed if they were not public facing. Both flexibilities are coming to an end.
In 2020, when the PHE was first declared, the federal government changed or halted many of its rules and regulations on how care is delivered. During the PHE, rules were relaxed regarding staff training in nursing home facilities. There was also easier virtual access to prescribe medications pertinent in treatment relating to addiction.
In hospitals, the broader use of nurse practitioners and physician assistants was implemented to ensure there were enough healthcare workers to treat patients. Another hospital exception that will be terminated once the PHE ends is “CMS allowing hospitals to make broader use of nurse practitioners and physician assistants when caring for Medicare patients. New physicians not yet credentialed to work at a particular hospital — for example, because governing bodies lacked time to conduct their reviews — could nonetheless practice there,” (Pradhan, Rachana – CBS News). Regarding monitoring the disease, because the Department of Health and Human Services will no longer be able to require labs to report Covid-19 testing data, the way local and state public health departments monitor the spread of disease will change. It is expected that while at-home test kits will no longer be free, and hospitals will most likely provide Covid-19 data less frequently, that surveillance will need to be strategized.
“From Addiction Treatment to Nursing Homes, End of COVID Emergency Will Bring Changes across U.S.
Health Care System.” CBS News, CBS Interactive, https://www.cbsnews.com/news/covid-public
Morse, S. (n.d.). Providers granted 90 days following end of phe to comply with HIPAA Telehealth Rules. Healthcare
Finance News. Retrieved April 17, 2023, from https://www.healthcarefinancenews.com/news/providers
(OCR), Office for Civil Rights. “HHS Office for Civil Rights Announces the Expiration of COVID-19 Public Health
Emergency HIPAA Notifications of Enforcement Discretion.” HHS.gov, 11 Apr. 2023,
Watson, Kathryn. “Biden Signs Bills to Reverse D.C. Criminal Code Changes and Declassify Info on Covid
19 Origins.” CBS News, CBS Interactive, 20 Mar. 2023, https://www.cbsnews.com/news/biden-dc-crime-bill-covid-19-origins/.
On November 1st, the Centers for Medicare and Medicaid Services (CMS) released their final Medicare Physician Fee Schedule (PFS). This new and final 2023 ruling affects not only Medicare payout to physicians, but the Merit-based Incentive Payment System (MIPS), and the alternative payment model (APM) as well.
“Anesthesia Conversion Factor, work Relative Value Units (RVUs) for several pain medicine codes, and policy updates for the 2023 QPP performance year will be effective January 1, 2023. Absent Congressional action, all physician practices – including anesthesiologists and their groups – will face significant Medicare payments cuts next year,” (American Society of Anesthesiologists). Anesthesia being the most affected, with a 4.47% decrease from the rates in the current year of 2022. This decrease may seem small, but it will make a big impact as the year goes on.
With this finalized ruling, we will also see extended telehealth provisions that was put in place due to the public health emergency. Once the PHE is declared as finished, to ensure a smooth transition, they have chosen to extend the provisions by 151 days – “including allowing payment for RHCs and FQHCs for furnishing telehealth services as distant site practitioners (though note that mental health visits can be furnished virtually on a permanent basis) under the payment methodology established for the PHE, allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, and allowing certain services to be furnished via audio-only telecommunications systems,” (CMS.gov).
“MGMA submitted detailed comments in response to the proposed rule in September. Be on the lookout for a more detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP) in the coming weeks,” (MGMA Regulatory Alert).
For more information, and to keep up to date on policy changes, please follow the following links or sources:
“Fact Sheet Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule.” CMS, https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule?utm_source=email&utm_medium=marketo&utm_campaign=gov-washingtonconnection-oct-2022-regalert1031&mkt_tok=MTQ0LUFNSi02MzkAAAGH1B6DQSAYQZNXcZCy3E_z53VOq5t7ZbNvsM5maFQZnsPwXfV3TSCRCRJOnFGeC08dWNFDKMtCP8mJhXaa8C_S9kuhEONhijo_bV39AX_9cQ.
“CMS Provides Little Relief for Anesthesia Groups in Release of 2023 Payment Rules.” American Society of Anesthesiologists (ASA), https://www.asahq.org/advocacy-and-asapac/fda-and-washington-alerts/washington-alerts/2022/11/cms-provides-little-relief-for-anesthesia-groups-in-release-of-2023-payment-rules#:~:text=CMS%20has%20finalized%20significant%20cuts,2022%20anesthesia%20CF%20of%20%2421.5623.
My husband is in the Reserves, and he served overseas in 2004. From that experience, I know how much our troops appreciate care packages and mail, which is why I began volunteering with Aaron’s Gifts From Home more than three years ago.
Aaron’s Gifts was founded in 2012 by the parents of Aaron Ullom, a service member in the Navy who was killed in action in Afghanistan. In honor of Aaron’s memory, the organization sends care packages to soldiers stationed overseas. The packages include comic books, DVDs, snacks and games – anything a service member might enjoy.
Roughly three times a year, a group of us get together to pack hundreds of boxes for active-duty service members. I am proud that I have the opportunity to give back to those serving our country and protecting our freedoms. Aaron’s Gifts is truly a great organization, and I am so appreciative that I get to be part of it.
I give back because I want to support those who serve our country.
A vote is expected to be made soon within the Senate regarding the extension of COVID-19 temporary waivers; The House of Representatives voted 416-12 to pass the “Advancing Telehealth Beyond COVID-19 Act.” This legislation would continue Medicare patient access to telehealth services, including audio-only services. This extension, if passed within the Senate, will extend temporary waivers that have been put in place due to the PHE all the way through December 31, 2024. Below is a list of continuing waivers from Karen Zupko & Associates Inc.:
- Continuing the pause on geographic restrictions limiting the patient’s location to a metropolitan statistical area (MSA) or a rural health professional shortage area (HPSA) (some exceptions). The patient’s home is still an acceptable location.
- Allowing the expanded list of eligible providers (i.e., PT, OT, SLP, and audiologists) to continue to provide telehealth services on the Medicare approved list within their scope of practice.
- Continuing coverage for non-mental health audio-only visits.
- Continue allowing FQHCs and RHCs to be distant site telehealth providers for non-mental health visits.
- Delaying certain mental health visit requirements for in-person visits.
- Allowing telehealth to satisfy face-to-face encounters before hospice care recertifications.
kpage_drupal. “House-Passed Bill Would Extend Medicare Telehealth Flexibilities : AHA News.”
American Hospital Association | AHA News, https://www.aha.org/news/headline/2022-07-28
“KZA Telehealth Solutions Center.” KZA Telehealth Solution Center – Access Page,
During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) enacted several temporary emergency declaration blanket waivers. The waivers were intended to provide health care providers with extra flexibility.
On April 7, 2022, CMS issued memorandum QSO-22-15 that will end many of the blanket waivers for specific providers in 30 and 60 days from publication of the memo.
Of note, one waiver that will end provides the capacity for physicians and practitioners to conduct visits via telehealth options. Effective May 7, 2022, visits to nursing home residents must be performed in person.
Providers are expected to take immediate steps so that they may return to compliance with the reinstated requirements.
Please contact Yeo & Yeo if you have questions or need assistance.
The Health Resources & Services Administration (HRSA) announced an opportunity for providers to submit a Request to Report Late Due to Extenuating Circumstances for PRF Reporting Period 1 if one or more of the extenuating circumstances described below apply.
Providers will be able to submit a Request to Report Late Due to Extenuating Circumstances for Reporting Period 1 from Monday, April 11 to Friday, April 22, 2022, at 11:59 p.m. ET.
HRSA explains that the only providers who meet one or more of the identified extenuating circumstances will be eligible to submit a Late Reporting Request for Reporting Period 1. These circumstances include:
- Severe illness or death of a provider or key staff member responsible for reporting
- Impacted by a natural disaster
- An incorrect email or mailing address on file with HRSA prevented the organization from receiving instructions prior to the Reporting Period deadline
- The provider registered, completed their report but forgot to click the “submit” button before the deadline
- An internal miscommunication or error about who was authorized and expected to report on behalf of the organization and/or the registered point of contact
- An incomplete targeted distribution report where the parent organization completed all General Distribution payment reports but a targeted distribution was not reported on by the subsidiary
The provider must indicate and attest to a clear and concise explanation of the applicable extenuating circumstance; however, supporting documentation will not be required.
If HRSA approves the request, the organization will receive a notification to proceed with completing the Reporting Period 1 report. Providers will have ten days from the date they receive the notification to submit a report in the PRF Reporting Portal. There will be no extensions to this timeline, so providers should prepare their documentation as soon as possible and be ready to file once notified that they are approved. Providers can review the PRF Reporting Portal User’s Guide to help them determine what information will be required.
Providers who plan to submit a Request to Report Late Due to Extenuating Circumstances, but have not registered in the PRF Reporting Portal, should complete registration prior to submitting their request. Registration instructions are on the PRF Reporting webpage.
Note that providers will also have an opportunity to submit a Request to Report Late Due to Extenuating Circumstances for Reporting Period 2 if the extenuating circumstances are applicable. Providers will receive a notification regarding the process to submit a request for RP2 in the coming weeks.
As of March 22nd, 2022, the HRSA (Health Resources and Services Administration) will no longer reimburse healthcare providers for claims submitted for COVID-19 testing and treatments of uninsured patients. Starting April 5th, 2022, they will stop accepting claims for vaccinations against COVID-19 as well. However, according to the CDC, COVID-19 Vaccination Program Providers must continue to administer COVID-19 vaccines at no out-of-pocket cost to recipients. This Uninsured Program was provided during the COVID-19 pandemic to provide healthcare providers reimbursement for Covid testing, treatments, and administering vaccinations. These reimbursements typically came within 30 days and were generally Medicare rates.
Any claims submitted for testing and treatments after March 22nd will not be reviewed for reimbursement, and after April 5th, claims for vaccinations will not be reviewed. This decision was made due to lack of sufficient funds. Claims that were submitted before the deadlines will be put into review and reimbursed according to availability of funds. The HRSA anticipates that claims submitted by the deadline may take longer than the typical 30 business day timeframe to process to determine the availability of funds. There are other resources are available to providers and/or uninsured individuals after the deadlines have passed. Alternative resources for uninsured individuals who need COVID-19 services or need assistance with other medical expenses and procedures are listed below:
- Medicaid enrollment
- Healthcare marketplace enrollment
- gov – Find a Health Center
For more information, please visit https://www.hrsa.gov/
On March 15, 2022, President Biden signed a $1.5 trillion spending package into law, extending telehealth services relating to the PHE. Summed up below are the waivers that will be in effect for another 151 days after the PHE Covid-19 has concluded (April 16th, 2022):
- “Originating site and geographic location” – Patients can continue to be treated via telehealth communication anywhere
- “Qualifying providers” – Furnishing distant site telehealth services can be provided by physical therapists, occupational therapists, speech language pathologists, and audiologists
- “Audio-only services” – These services must continue to be covered and reimbursed by CMS
- “Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)” – Can be distant sites and can be reimbursed
- This also delays in-person visitation requirements for mental telehealth visits for 152 days after the conclusion of the PHE
For more information about the mental telehealth expansions, see MGMA’s 2022 final Physician Fee Schedule analysis.
Yeo & Yeo is pleased to announce that Kati Krueger, CMPE, President of Yeo & Yeo Medical Billing & Consulting, was recognized as one of ten recipients of the 2021 RUBY Awards presented by 1st State Bank.
Krueger was honored among the area’s brightest professionals under the age of 40 who have made their mark in their professions and are having an impact throughout the Great Lakes Bay Region.
“This award recognizes Kati’s leadership and her commitment to continuous improvement for the benefit of our clients,” said Dave Youngstrom, Yeo & Yeo’s President & CEO. “She is disciplined, dedicated and highly respected by her staff. She has a passion for building up those around her, and she is a great ambassador for Yeo & Yeo in the community and the associations she is affiliated with.”
Krueger began as a co-op student with Yeo & Yeo Medical Billing & Consulting (formerly Affiliated Medical Billing) in 2002. After graduating from Saginaw Valley State University, she advanced to Marketing Assistant, Marketing Manager, Billing Manager, and then a year as vice president. In 2017, the company changed its name to Yeo & Yeo Medical Billing & Consulting, and she took the reins as president.
Under Krueger’s leadership, the company has undergone significant transformation in its operations, recognizing greater efficiencies for staff and clients. Krueger has led several significant technology advancements within the billing company, most recently implementing bots to further streamline workflows and processes. Clients look to her as a resource for solving the operational and financial challenges of running a successful medical practice.
“I am honored to be recognized alongside so many of our community leaders,” Krueger said. “I am incredibly proud of my entire team who help support our company and our clients. I couldn’t have achieved this without all of you.”
Krueger’s expertise lies in serving the firm’s healthcare clients in all aspects of medical billing, coding and practice management, and serving as a highly effective leader for Yeo & Yeo Medical Billing & Consulting’s staff. She is a strong mentor, and her experience in marketing and business development has led the team toward solid growth.
Krueger is a member of the Medical Group Management Association, the Michigan Medical Group Management Association and the Health Care Compliance Association. In the community, she serves as a volunteer at Nouvel Catholic Central Elementary School.
Amid the global COVID-19 pandemic, the federal tally shows that a record number of major health data breaches were reported in the U.S. in 2021. The overwhelming majority of them involved hacking/IT incidents.
As of January 17, the Department of Health and Human Services’ HIPAA Breach Reporting Tool website shows 713 major health data breaches affecting more than 45.7 million individuals posted for 2021.
4 Common Date Breaches
- Hacking/IT incidents were the most dominant type of health data breach. Hacking/IT incidents were involved in 73% of all 2021 breaches posted to the HHS website so far, but those incidents were responsible for about 94% of individuals affected.
- Some 147 “unauthorized access/disclosure” breaches affected more than 2.2 million individuals in 2021. That’s about 20% of total breaches and about 4.8% of those individuals involved in 2021.
- Only 16 loss/theft breaches involving unencrypted computing devices – such as laptops and mobile storage gear – were posted to the HHS website in 2021. Those incidents, which were the primary source of significant health data breaches in years past, affected fewer than 100,000 individuals in 2021.
- Business associates were reported as being involved in 251 breaches affecting 21.3 million individuals in 2021. That means vendors and other business associates handling protected health information were involved in about 35% of major HIPAA breaches in 2021. Those business associate incidents affected about 46% of all individuals affected by major health data breaches last year.
Driving Forces Behind Cyberattacks
“Breaches will increase as businesses continue to automate more. Data is the new currency in the cyber world,” says Tom Walsh, founder of privacy and security consultancy tw-Security.
But that is not just a healthcare sector problem, some professionals note. “I assume the number of breaches across industries has risen. [This] goes along with the worldwide nature of cyber business and security and crime. And the pandemic exacerbates it all,” says Kate Borten, president of privacy and security consultancy The Marblehead Group.
Hacking incidents, in particular, will continue to plague the healthcare sector, Walsh says. “Hackers have stepped up their efforts. With new tools available, it’s even easier for someone with basic experience to launch a more sophisticated attack,” he says.
Walsh says hackers had to be technically skilled in operating systems and software to launch an attack successfully. But now, software-as-a-service tools and tools using artificial intelligence are making it easier for novice hackers.
Medicare was scheduled to set large physician cuts in motion at the beginning of 2022. As of December 9th, 2021, Congress has passed legislation that prevents those cuts from taking place. This legislation lessens the severity of the -3.75% impact that Medicare was planning to make by 3%. This mitigation expressed by Congress has to do with the previously delayed 2021 budget neutrality adjustments that were set to affect the physician fee schedule in 2022.
This legislation invalidates the required 4% pay-as-you-go sequester that was a result of the American Rescue Plan Act for 2022, as well as delaying reinstatement of Medicare’s current 2% sequester until March of 2022. Plans are to phase in a 1% sequester through June of 2022. “Sequestration is the automatic reduction (i.e., cancellation) of certain federal spending, generally by a uniform percentage. The sequester is a budget enforcement tool that was established by Congress in the Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA, also known as the Gramm-Rudman-Hollings Act; P.L. 99-177, as amended) and was intended to encourage compromise and action, rather than actually being implemented (also known as triggered). Generally, this budget enforcement tool has been incorporated into laws to either discourage or encourage certain budget objectives or goals. When these goals are not met, either through the enactment of a law or the lack thereof, a sequester is triggered and certain federal spending is reduced,” (Congressional Research Service, 2021).
Further delays have been brought into motion due to this legislation being passed; cuts to physician office laboratories and the next round of data reporting are only just a few. Congress has expressed their gratitude for the thousands of letters sent by MGMA members that prevented Medicare from subjecting physician offices to payment reductions. They are still calling upon Congress to reform current policies that allow such things (such as the Medicare sequester) to take place unless a movement is made by MGMA, Congress, etc.
Medicare and Budget Sequestration. https://sgp.fas.org/crs/misc/R45106.pdf
“Medical Group Management Association.” MGMA, https://www.mgma.com/
Unexpectedly, the United States Department of Health and Human Services has reopened the Provider Relief Fund portal as of December 13th at 9:00 AM ET. This grants more time to those providers and offices that did not get a chance to complete and submit of reports for the first reporting period. The portal will be open for submissions from December 13th 2021 to December 20th 2021 at 11:59 PM ET.
Medical practices and providers that have already submitted a report for the first reporting period can access their report if there are errors that need to be corrected. Please contact the provider support line at (866) 569-3522 to be granted access to your submission. Take into account that the second reporting period will begin at the first of the new year on January 1st, 2022.
To access the portal, please follow the link above or visit https://prfreporting.hrsa.gov/
Starting January 1st 2022, changes within Medicare’s physician fee schedule will take effect. These changes that were issued on November 2nd, 2021, will update policies for Medicare payments. “The calendar year (CY) 2022 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation,” (CMS, 2021).
Previously, for a majority of services that were performed in the office setting, Medicare made their payments on a single rate based on the resources involved in performing the service. Starting in 2022, CMS released a series of proposals that include standard rate-setting refinements. With these changes starting January 1st 2022, CMS is authorizing Medicare to make direct payments to physician assistants for services they perform under Medicare part B. As it stands right now, Medicare can only make payments to the employer or independent contractor. “The 2022 Physician Fee Schedule proposed regulatory changes would align policies with the Federal statute of the Consolidated Appropriations Act of 2021 [section 403]. The act amends the Social Security Act and removes the requirement that payment for services performed by PAs be made to their employer and allow payment to be made directly to a PA,” (DePalma).
Along with the changes to the PA PFS, these proposals “revise telehealth services under the Consolidated Appropriations Act, 2021, which allows use of audio-only communications technology when furnishing mental health services in certain circumstances. It also finalizes recent changes to Evaluation and Management (E/M) visit codes, such as policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physicians. Modifications are also being made to payments for therapy services furnished in whole or in part by a Physical Therapist Assistant or Occupational Therapy Assistant. Updates to payment regulation for Medical Nutrition Therapy services are similarly being added as well as finalization for vaccine administration services,” (CMS, 2021).
Please follow this link for the original article pertaining to the above information.
“Fact Sheet Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule.” CMS,
“Physician Fee Schedule.” CMS, https://www.cms.gov/Medicare/Medicare-Fee-for-Service
“Physician Assistants Will Benefit with Direct Pay under CMS Proposed Rule.” Healio,
The Department of Health and Human Services has extended the PHE (public health emergency) for Covid-19; this newest order went in to effect on October 18, 2021. For another 90 days, all “telehealth waivers and other flexibilities pursuant to the PHE determination” will continue. This pushes the most current PHE declaration to end on January 16, 2022. Indicated by the Biden Administration, they intend to give the healthcare community 60 days’ notice before allowing the PHE to lapse in order to give them time for preparation. You can view the full renewal here.
This renewal will be the 8th order revolving around Covid-19 nationally. The initial order titled “Determination that a Public Health Emergency Exists Nationwide as the Result of the 2019 Novel Coronavirus,” was put into effect on January 31, 2020. On April 21, 2020, this PHE was extended, and is also when this disease got its name that we know it as now “Coronavirus; Covid-19.” According to the CDC, “an outbreak is called an epidemic when there is a sudden increase in cases. As COVID-19 began spreading in Wuhan, China, it became an epidemic. Because the disease then spread across several countries and affected a large number of people, it was classified as a pandemic.”
A new surprise billing rule that “establishes dispute resolution process for patients, providers, and plans,” was released recently in September of this year. The Department of Health and Human Services released an addition to the rules that outlines the “No Surprises Act.” The No Surprises Act “prohibits balance billing in the case of surprise medical bills — those for non-emergency services furnished by out-of-network providers during a visit by the patient at an in-network facility — unless the law’s notice and consent requirements are met,” (National Law Review, Cummings). This act was first introduced as a part of the Consolidated Appropriations Act, which was enacted in December of 2020.
“A surprise bill is an unexpected bill from a health care provider or facility. This can happen when a person with health insurance unknowingly gets medical care from a provider, facility, or provider of air ambulance services outside their health plan’s network. Surprise billing happens in both emergency and non-emergency care settings,” (CMS, 2021). In an emergency, the patient will be treated by the facility nearest them; this can result in care being performed by those not in-network with the patient’s insurance. In non-emergency cases, patients may have chosen a facility and/or physician that is in-network with their insurance, however, someone behind the scenes of their care, for example a radiologist or an anesthesiologist, may not be in-network. This can cause an outstanding bill for the patient that they were not expecting, which is where this No Surprises Act comes into play.
This new rule continues to protect patients against surprise medical bills by following through with out-of-pocket limits, and requiring patient consent before performing any medical procedures or examinations. Along with following previous procedures and ideals for this rule, MDHHS has included a new process and guidelines for independent dispute resolution (IDR). This allows patients to dispute a surprise medical bill when the care provided was not discussed and approved beforehand. Patients will also be granted good faith estimates for uninsured (or self-pay) individuals. Patient-provider dispute resolution processes are outlined in this new rule, allowing patients to discuss these matters directly with their medical provider with expanded rights to external review. The process that agencies will use to evaluate the IDR disputes are outlined as well. IDR will be implemented starting at the first of the year in 2022. The Federal Register released the second interim final rule on their website.
Please visit the new CMS Surprise Billing Page for all of the latest updates. “The Departments and OPM intend to post additional information over the next several months, including information about how to initiate an independent dispute resolution process in the federal portal, and plan to highlight different provisions as they become more relevant to different stakeholders and audiences,” (CMS, 2021).