April 30, 2020

Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic - CLICK HERE

April 27, 2020

CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program

On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to health care providers and suppliers through these programs and in light of the $175 billion recently appropriated for health care provider relief payments.

CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the 2019 Novel Coronavirus (COVID-19). Funding will continue to be available to hospitals and other health care providers on the front lines of the coronavirus response primarily from the Provider Relief Fund. The Accelerated and Advance Payment (AAP) Programs are typically used to give providers emergency funding and address cash flow issues for providers and suppliers when there is disruption in claims submission or claims processing, including during a public health emergency or Presidentially-declared disaster.

Since expanding the AAP programs on March 28, 2020, CMS approved over 21,000 applications totaling $59.6 billion in payments to Part A providers, which includes hospitals. For Part B suppliers, including doctors, non-physician practitioners and durable medical equipment suppliers, CMS approved almost 24,000 applications advancing $40.4 billion in payments. The AAP programs are not a grant, and providers and suppliers are typically required to pay back the funding within one year, or less, depending on provider or supplier type. Beginning today, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through the Department of Health & Human Services’ (HHS) Provider Relief Fund.

Significant additional funding will continue to be available to hospitals and other health care providers through other programs. Congress appropriated $100 billion in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (PL 116-136) and $75 billion through the Paycheck Protection Program and Health Care Enhancement Act (PL 116-139) for health care providers. HHS is distributing this money through the Provider Relief Fund, and these payments do not need to be repaid.

The CARES Act Provider Relief Fund is being administered through HHS and has already released $30 billion to providers and is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. This funding will be used to support health care-related expenses or lost revenue attributable to the COVID-19 pandemic and to ensure uninsured Americans can get treatment for COVID-19.

For more information on the CARES Act Provider Relief Fund and how to apply, visit: hhs.gov/providerrelief.

For an updated fact sheet on the Accelerated and Advance Payment Programs, visit: https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf.

April 8, 2020

Update from CMS

CMS Waivers and COVID-19 Response.  Please see the attached presentation by the Principal Deputy Administrator for Operations of CMS, Kimberly Brandt. We are going to use this tool to have conversations with our local stakeholders. 
Download Presentation (pdf download)

April 6, 2020

CMS COVID-19 Updates: Video on telehealth; additional Medicaid waivers; and Ambulatory Surgical Center guidance.

New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.


CMS Approves Additional State Medicaid Waivers and Amendments to Give States Flexibility to Address Coronavirus Pandemic

CMS approved its 45th Medicaid waiver to the District of Columbia, delivering urgent regulatory relief to ensure the District can quickly and effectively care for their most vulnerable citizens. In light of the urgent and evolving needs of states during the COVID-19 crisis, CMS developed a toolkit to facilitate expedited application and approval of State waivers requests in record time. The waivers support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

CMS also approved an additional state waiver amendment request for Oklahoma to give emergency flexibilities in their programs that care for the elderly and people with disabilities, bringing the total to 18 approvals across 16 states.

Section 1135 Waivers  

1915(c) Appendix K Waivers

Guidance for Processing Attestations from Ambulatory Surgical Centers (ASCs) Temporarily Enrolling as Hospitals during the COVID-19 Public Health Emergency

CMS is providing needed flexibility to hospitals to ensure they have the ability to expand capacity and to treat patients during the COVID-19 public health emergency. As part of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers CMS is allowing Medicare-enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients.



March 30, 2020

Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 (pdf download)

The Trump Administration is issuing an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. Made possible by President Trump’s recent emergency declaration and emergency rule making, these temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. The goals of these actions are to 1) to ensure that local hospitals and health systems have the capacity to handle a potential surge of COVID-19 patients through temporary expansion sites (also known as CMS Hospital Without Walls); 2) remove barriers for physicians, nurses, and other clinicians to be readily hired from the community or from other states so the healthcare system can rapidly expands its workforce; 3) increase access to telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home; 4) expand in-place testing to allow for more testing at home or in community based settings; and 5) put Patients Over Paperwork to give temporary relief from many paperwork, reporting and audit requirements so providers, health care facilities, Medicare Advantage and Part D plans, and States can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.

March 27, 2020

COVID-19 legislative alert: Congress passes CARES Act, heads to President's desk

This afternoon, Congress passed the “Coronavirus Aid, Relief, and Economic Security (“CARES”) Act, which provides relief to medical practices during the COVID-19 public health emergency. The bill will now make its way to President Trump’s desk to get signed into law. As a result of MGMA advocacy, this legislation:

  • Provides $100 billion to healthcare providers and hospitals to ensure they continue to receive the support they need for COVID-19 related expenses, such as PPE, and lost revenue;
  • Creates a “paycheck protection program” that provides 8 weeks of cash-flow assistance to small businesses, including medical groups, that are under 500 employees;
  • Temporarily suspends the 2% Medicare sequestration from May 1. through Dec. 31, 2020; and
  • Gives the Secretary flexibility to waive additional Medicare telehealth requirements, opening the door for payment for audio-only communications.

MGMA Government Affairs has provided a high level summary of key provisions in the law that affect medical groups.

Coronavirus Aid, Relief and Economic Security Act (CARES Act) - (pdf download)
(Kassouf & Co.)

On March 27, 2020, the President signed the Coronavirus Aid, Relief and Economic Security Act ("CARES Act").  This Bill provides a number of potential benefits for businesses and individuals impacted by the Coronavirus. 

March 25, 2020

Overview of the Department of Labor's Guidance Explaining Emergency FMLA and Paid Sick Leave in the Families First Coronavirus Response Act (pdf download)
(Burr and Forman, LLP)

March 24, 2020

Updates for 2019 MIPS Data Submission
ATTENTION: Eligible Medicare Clinicians Participating in MIPS

CMS has extended the 2019 MIPS data submission deadline to 8:00 PM EDT on April 30, 2020. You can submit data via the QPP website here.

Additionally, eligible clinicians who have not submitted any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year.

For 2020 MIPS, CMS is currently evaluating options for providing relief around participation and data submission. Look for more information from CMS in the coming months.

For assistance with the data submission system, contact Quality Payment Program at qpp@cms.hhs.gov or 866-288-8292 or visit the QPP website.

For information on the Medicaid Promoting Interoperability deadline extension please visit this link.


March 23, 2020

Today, the Trump Administration released new tools to strip away regulatory red tape and unleash new resources to support state Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) outbreak. Because of the President’s bold action in declaring COVID-19 a national emergency, CMS now has a full suite of tools available to maximize responsiveness to state needs. The agency has created four checklists that together will make up a comprehensive Medicaid COVID-19 federal authority checklist to make it easier for states to receive federal waivers and implement flexibilities in their program. 

The tools include:

·      1115 Waiver Opportunity and Application Checklist

·      1135 Waiver Opportunity and Application Checklist

·      1915(c) Appendix K Template

·       Medicaid Disaster State Plan Amendment Template

You can find a copy of the press release here.

These tools, and earlier CMS actions in response to the COVID-19 emergency, are all part of ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, please visit www.coronavirus.govFor a complete and updated list of CMS actions, guidance, and other information in response to COVID-19, please visit the, please visit the Current Emergencies Website


March 22, 2020

Today, the Centers for Medicare & Medicaid Services (CMS) announced unprecedented relief for the clinicians, providers, and facilities participating in Medicare quality reporting programs including the 1.2 million clinicians in the Quality Payment Program and on the front lines of America’s fight against the 2019 Novel Coronavirus (COVID-19).

Specifically, CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs.

Read the full story here.


March 17, 2020

A new current procedural terminology (CPT) code and description has been created for novel coronavirus (COVID-19) testing, according to the American Medical Association (AMA).

The CPT code is 87635, and is a child code listed beneath parent code for microbiology procedures (87471). The description of the code is: “Due to the emergent nature of the public health concern surrounding novel coronavirus testing, the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel convened a special meeting and approved a new, specific CPT code to describe laboratory testing for [COVID-19],” the AMA’s coding fact sheet reads.

Because the code is new, healthcare organizations will need to manually upload it into their EHR systems.

For a fact sheet that includes the code’s descriptor and purpose, a clinical example, a description of the procedure and frequently asked questions, please visit the AMA website.