COVID-19

Physicians Advocacy Institute

COVID-19 Related Resources for Physicians

Our nation’s physicians, nurses and other health care providers are putting their lives on the line every day to care for patients suffering from COVID-19.  In addition, many physician practices are experiencing severe financial distress as patients who aren’t infected with COVID-19 are under orders to shelter-in-place and to delay non-essential care.  

The federal government has passed a series of legislative and regulatory measures to allow physicians and other health care providers certain regulatory flexibilities and relief during this period. These measures include policies to help health care providers financially through enhanced payments and various loan programs.

PAI is closely tracking these policies and programs, including the impact they are having for physicians and their ability to sustain medical practices in order to care for their patients.  PAI is also actively advocating for ongoing, meaningful financial support for physician practices and relief from unnecessary regulatory burdens during this crisis.


COVID-19 Related Resources For Physicians

PAI COVID-19 Policy Newsletter
PAI has partnered with Healthsperien Consulting to provide real time policy updates and analysis on COVID-19-related policies and programs that impact physician practices. PAI and its state medical associations affiliates are working to share relevant information about COVID-19-related policies and programs with physicians across the country.  Sign up for PAI Newsletters here.

PAI COVID-19 Regulatory Update – March 27, 2020 – Medicare QPP-related and Telehealth flexibilities
PAI COVID-19 Regulatory Update – April 7, 2020 – Regulatory relief and CARES Act provisions
PAI COVID-19 Regulatory Update – April 17, 2020 – Physician Financial Support
PAI COVID-19 Regulatory Update – May 26, 2020

Federal COVID-19-Related Policies:  Financial Support for Physician Practices
A critically important aspect of the federal government’s pandemic response has been to adopt a series of legislative and regulatory measures to address the financial burden that health care providers, including physician practices, are facing.  The most significant and comprehensive vehicle is the enactment of the CARES Act, which was signed into law on March 27. The $2-plus trillion stimulus package includes several provisions addressing the health care sector, as well as employer and economic supports.  

Key Financial Supports

  • Medicare Sequester Delay.  The CARES ACT delays the 2% Medicare sequestration beginning May 1, 2020, for the duration of the COVID-19 Emergency period. This provides an overall increase in reimbursement by 2%.
     
  • Public Health and Social Services Emergency Relief Fund.   The CARES Act appropriates $100 billion to be directed towards health care related expenses or lost revenues attributable to COVID-19.  CMS distributed an initial $30 billion from the “Relief Fund” in mid-April to eligible physician practices and other health care providers based on Medicare Part B billings in 2019. HHS is releasing the second "general distribution" allocation of these Provider Relief Funds funds totaling $20 billion to providers who apply and qualify via a Provider Relief Fund Application Portal.  Providers must have billed Medicare in 2019 and received funding in the first release of general distribution funds to qualify.  Providers must also submit information regarding gross receipts from federal tax returns, estimated losses in March/April 2020 due to COVID-19 and a copy of their most recently filed federal income tax return.  More information on this process is available here.
     
  • Small Business Supports Available to Eligible Physician Practices.  Many physician practices qualify as small businesses that can access financial support options that the CARES Act made available through new Small Business Administration (SBA) loans, which work as grants if conditions are met.  Physician practices can apply through the SBA-administered “Paycheck Protection Program” (PPP) and Economic Injury and Disaster Loans and Advancements (EIDLs).  The CARES Act also provides certain tax relief available to physician practices and other small businesses. For more information, see PAI April 17 COVID-19 Newsletter  or Healthsperien’s COVID-19 Small Business Supports Summary.

    For information about how to access these financial resources, please see  Small Business Owner’s Guide to the CARES Act, SBA page, and the US Chamber of Commerce CARES Act FAQs.
     
  • The Medicare Accelerated and Advance Payment Program.  In March, CMS issued a new policy to temporarily expand the Medicare APP to allow Medicare Administrative Contractors (MACs) to advance Medicare payments to eligible Medicare providers in order to offset cash flow issues.  These payments are subject to repayment through recoupment processes.  This program was suspended on April 27, 2020.
     
  • Malpractice Liability Protection for Volunteer Physicians. The CARES Act suspends medical malpractice liabilities under both Federal and State laws for health care professional volunteers providing or withholding health care services in good faith during the national public health emergency with respect to COVID-19. These protections would not apply for harm incurred due to gross negligence or reckless misconduct of the provider, including but not limited to providing care under the influence.
    • For additional information, please see Secretary Azar’s previous guidance advising states to temporarily rollback several restrictions, including alleviating medical malpractice liabilities for in-state providers (including volunteers) across state lines. Since the beginning of the PHE, several states have instilled liability flexibilities for their respective health care communities.
       
  • Increased Funding for PPE.  The CARES Act appropriated $100 million to cover the costs of testing, providing services, and PPE related to COVID-19.

Federal COVID-19 Related Policies:  Regulatory Relief

Federal regulators have taken several steps to alleviate various regulatory burdens facing health care providers during this period.  On March 30th, CMS issued the Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency interim final rule (IFR).  For a full detailed summary of the interim rule, please view Healthsperien’s section-by-section summary. Additionally, please see CMS’s Fact Sheet on Physician and Other Clinicians Waivers and visit CMS waivers website for information on additional blanket waivers.

The IFR provides several new flexibilities for existing telehealth and other remote communication services, made effective retroactively as of March 1. This IFR builds on other flexibilities previously provided by CMS in March. CMS has also released information on additional blanket waivers, including important flexibilities for physicians-owned hospitals, Physician Self-Referral (Stark) Law, and other requirements.

Telehealth-Related Flexibilities. A series of federal policy changes offer significant expansion of telehealth services to allow physicians and other health care providers to care for Medicare patients remotely. States and Commercial health insurers have also relaxed various requirements to allow for more extensive telehealth visits during this period.  Matthew Katz, PAI's Consultant and founder of MCK Health Strategies, reviews these telehealth flexibilities and payment/billing policies in this 30-minute webinar:

Download and Share: "Responding to COVID-19:  Telehealth Expansion" slide deck

Key policies include:

  • Expanded list of approved telehealth services. An updated list can be found here.
  • CMS continues to apply enforcement discretion for “established patient” requirements, as well as originating site requirements for such services.
  • Physicians are instructed to bill for telehealth services as if the services were furnished in person, with the in-person Place of Service code, and with Modifier 95 to indicate that it was furnished via telehealth. This will ensure that physicians are reimbursed for telehealth services at the same amount as if the services were furnished in person.
  • Allows CMS to reimburse for E/M services provided through audio-only communication (i.e., telephone E/M; CPT codes 98966-98968 & 99441-99443).
  • Waives several face-to-face requirements (as it pertains to certain ESRD services, nursing home visits, and a large majority of current National- and Local Coverage Determinations) and allows certain required assessments to be completed through telehealth. Also removes certain frequency limitations.
  • Communication Technology-Based Services (CTBS) & Remote Patient Monitoring
  • Allows virtual check-ins and e-visits to be provided to both established and new patients.
  • Allows RPM services to be provided/reimbursed for both established and new patients, as well as for patients with chronic and/or acute conditions (e.g., acute respiratory conditions). Also provides flexibilities for patient consent requirements associated with RPM services.
  • Removes/amends several supervision requirements, and allows certain supervision requirements to be achieved through telecommunications.

On April 30, CMS added additional flexibilities to promote telehealth services during the pandemic crisis: 

  • Waived video requirement for additional telephone evaluation and management (E&M) services.  
  • Extended payment parity for audio-only office/outpatient visits    
  • Extended audio-only coverage for many behavioral health services 

For more information, see the CMS News Release summarizing the new waivers and policies.

For more information, see Healthsperien’s Special Flexibility Summary: Telehealth

Medicare Quality Payment Program (QPP) flexibilities
CMS guidance released on March 22 provides relief from certain QPP-related requirements.  For information on QPP-related flexibilities, see PAI’s March 27 COVID-19 Newsletter