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Everything you need to know about BMD and the industry.

Ohio Chiropractors Can Now Provide Evaluation and Management Services to Medicaid Patients

The Department of Medicaid released a statement that Medicaid will cover low-and moderate level E&M services represented by CPT codes 99202, 99203, 99212, and 99213 when performed by a chiropractor. The Department of Medicaid will cover up to three E&M services per benefit year. The Department of Medicaid plans to make these changes effective by October 1, 2022.

IMPORTANT PRF UPDATE! HRSA Allows Providers the Opportunity to Correct Missed Period 1 Reporting

Late Wednesday, April 6, HRSA announced that it was going to allow providers with extenuating circumstances that prevented them from preventing a completed Period 1 Report to submit a Request to Report Late Due to Extenuating Circumstances.

Brennan Manna Diamond Congratulates 2022 Crain’s Cleveland Notables in Law

BMD Press Release

Changes to Medicare’s Physician Fee Schedule and Outpatient Prospective Payment System

Come the beginning of 2022, both the Medicare Physician Fee Schedule (“MPFS”) and Outpatient Prospective Payment System (“OPPS”) will look a little different. As a refresher, the MPFS lists the fees associated with reimbursement of services to providers at certain facilities, taking into account geography and costs. By contrast, OPPS sets reimbursement rates for hospitals and community mental health centers for outpatient services, which are determined in advance. A summary of some of the more pertinent changes to each rule will be outlined below.

CMS to Once Again Reprocess Outpatient Clinic Claims

The Hospital Outpatient Prospective Payment System (OPPS) Rule was passed in November 2018, which was intended to prevent the Centers for Medicare and Medicaid Services (CMS) from paying more for services rendered in outpatient settings than what they paid for the same services rendered in physician offices that are simply owned by hospitals or health systems.[1]

New Vaccine Requirement for Select CMS-Participating Facilities

On November 4, 2021, the Centers for Medicare and Medicaid (“CMS”) released a new rule requiring certain healthcare facilities to implement policies requiring employees to be vaccinated against COVID-19. It does not matter if a staff member does not perform patient treatment services, they must still be vaccinated if an employee of an applicable facility.

Changes to Physician Assistant Statutes in Florida

In the last year, there have been many changes to the scope of practice and collaboration/supervision requirements for advanced practice providers such as APRNs and physician assistants in the state of Florida. In a previous Client Alert we discussed House Bill 607, which expanded the autonomous practice of APRNs providing primary care services in Florida.

Primary Care Practice Officially Defined in Florida for APRNs Practicing Autonomously

As many providers in Florida are aware, House Bill 607 (the “Bill”), which was passed in February of last year, gives certain APRNs in Florida the ability to practice autonomously. The only catch is that they must work in primary practice. When the Bill was initially passed, there was question as to what was exactly considered primary care, absent a definition from the Florida Board of Nursing. However, as of February 25, 2021, “primary care practice” has officially been defined.

Part II of the No Surprises Act

The Department of Health and Human Services (“HHS”) published Part II of the No Surprises Act on September 30, 2021, which will take effect on January 1, 2022. The new guidance, in large part, focuses on the independent dispute resolution process that was briefly mentioned in Part I of the Act. In addition, there is now guidance on good faith estimate requirements, the patient-provider dispute resolution processes, and added external review provisions.

No Surprises Act – Notice Requirements

On July 1, 2021, the Biden Administration passed an interim final rule: Part 1 of the “Requirements Related to Surprise Billing Act,” in an attempt to curb excessive costs patients are required to pay in relation to surprise billing. The rule is set to take affect January 1, 2022, and will only affect those who are enrolled in insurance via their employers, as federal healthcare programs already prohibit this type of billing.[1]

Interim Final Rule for Surprise Billing

In an effort to implement the new bipartisan No Surprises Act, on July 1, 2021, the Department of Health and Human Services (HHS), along with the Departments of Labor and Treasury, issued an interim final rule to safeguard patients against unforeseen medical bills arising from out-of-network care.

What Telemedical Barriers Practices Face and How They Can Manage Them

The onset of the COVID-19 pandemic has led to many businesses and industries having to rapidly adapt new practices in order to stay profitable, and the healthcare industry is no exception. Although telehealth tools and practices have existed and been used since the Vietnam War, the pandemic has caused many individual healthcare practices to heavily rely on telehealth as a large portion of their service mix in order to continue to provide care for patients. Because of this rapid adoption of telehealth practices in order to combat the restrictions of COVID-19, the telemedicine industry’s revenue has exploded in the last year. Experts predict that telehealth will continue to grow in use beyond the current pandemic, estimating the industry’s worth to be $25 billion by 2025. However, this rapid adoption of telehealth was prompted out of need and has not been without its own barriers that practices now face.

American Heart Association's 2021 Go Red For Women

The BMD Season of Giving in 2020 was a great way to help out organizations that help others. Continuing community involvement in 2021, we will be looking to the American Heart Association's Go Red for Women campaign. Healthcare and Hospital Law Member and Vice President Amanda Waesch is the Chair of Go Red for Women for the American Heart Association, which is kicking off the 28 days of Heart Health. Show your support on February 5th with “Wear Red and Give” Day. Consider hosting a Jeans Day every Friday in the month of February at your place of business in support of Go Red For Women, even encouraging remote employees to participate. Snap a pic of your team members in their red gear and post on social media (socially distanced in person or a virtual group photo will work, too!) – see the toolkit here for sharing on your favorite social platforms. Click here to learn more and donate to the GRFW Campaign.

Provider Relief Funds – Continued Confusion Regarding Reporting Requirements and Lost Revenues

In Fall 2020, HHS issued multiple rounds of guidance and FAQs regarding the reporting requirements for the Provider Relief Funds, the most recently published notice being November 2, 2020 and December 11, 2020. Specifically, the reporting portal for the use of the funds in 2020 was scheduled to open on January 15, 2021. Although there was much speculation as to whether this would occur. And, as of the date of this article, the portal was not opened.

Did You Receive More than $750,000 in Provider Relief Funds?

The Provider Relief Funds (“PRF”) - authorized under the CARES Act - has been a vital tool for health care providers during the COVID-19 public health emergency. These funds have allowed providers to stay open and continue to offer care during these pressing times. While helpful, these funds do come with several important obligations. First, fund recipients are required to comply with certain record-keeping requirements as well as comply with certain balance billing prohibitions. See our Client Alert. Second, fund recipients are required to report their intent, use of funds, and other data elements, which helps promote transparency to the federal government. Please see our Client Alert on provider relief fund reporting requirements. Third, and perhaps a new concept for many providers, fund recipients of more than $750,000 must undergo a “single audit” to ensure program compliance and appropriate use of funds.

Important Updates Every Provider Should Know: Information Blocking

In December 2016, Congress passed the 21st Century Cures Act (“Cures Act”) which: (1) authorized funding for the National Institutes of Health to promote medical research and drug development, (2) implemented provisions aimed at addressing the prevention and treatment of mental illness and substance abuse, and (3) reformed certain standards of the Medicare program and federal tax laws to foster healthcare access and quality improvement.

David Scott & Amanda Waesch Promoted to Vice President Roles as Part of Continued Succession Planning

Brennan, Manna and Diamond (BMD), an entrepreneurial business law firm with six offices in Ohio and Florida, has promoted Columbus Office Managing Partner David Scott and Executive Committee Member Amanda Waesch to the position of Vice President.

HHS Delays Quarterly Reporting for Provider Relief Funds

There is good news for providers that received either (1) General Distributions from the HHS Provider Relief Funds [link to my article], or (2) Targeted Distributions from the HHS Provider Relief Funds [link to Ashley’s article]. HHS reversed its stance requiring quarterly reports for providers that received Provider Relief Funds and PPP loan monies. The initial quarterly reports would have been due by July 10, 2020. However, on June 13, 2020, HHS delayed the quarterly reporting requirement.

July 20 is Important Deadline for HHS Fund Distributions to Medicaid and CHIP Providers

On June 10, 2020, the U.S. Department of Health and Human Services (“HHS”) released details on the distribution of more CARES Act Provider Relief Fund payments. After allocating $50 billion to Medicare providers through its General Distribution fund, HHS has now announced that it will distribute $15 billion to eligible Medicaid and CHIP providers who apply by the deadline through a Targeted Distribution. Applicants must apply through the Enhanced Provider Relief Fund Payment Portal. The application form itself can be found on the HHS website and is due by July 20, 2020.

Important Updates, Deadlines, and Clarifications for the HHS Provider Relief Funds

On May 20, 2020, HHS made important updates and clarifications regarding the General Distribution payments to providers. Between April 10, 2020 and April 24, 2020, HHS distributed an initial $30 billion to providers based on the provider’s 2019 Medicare fee-for-service receipts. These funds were distributed automatically and providers did not need to submit an application in order to receive these funds. The funds were originally touted as a “no strings attached” stimulus payment reserved for healthcare providers. But HHS issued a 10-page Terms and Conditions and required that providers sign an attestation confirming receipt of the funds and agreeing to the Terms and Conditions.

Back to Work: Employer Documents

The return of the workforce brings a renewed set of documentation requirements for employers, particularly those employers with fewer than 500 employees and any companies who received PPP funds. Back in March, employers needed a COVID-19 Leave Form and a Remote Work Policy, but things have changed.

Important Items Every Provider Should Know if Accepting the HHS Provider Relief Funds

On April 10, 2020, the Department of Health and Human Services (HHS) issued $30 billion to healthcare providers as part of the Provider Relief Fund under the CARES Act. Providers will have 30 days from the date of receipt to access the HHS portal, attest to the payment, and accept the Terms and Conditions. The Terms and Conditions require providers to take substantial steps to ensure compliance.

Important Update and FAQs: HHS Tweaks Guidance on The CARES Act Provider Relief Fund Terms and Conditions

On April 10, 2020, many providers awoke to find electronic payment deposits from Department of Health and Human Services (HHS) in their bank accounts. This was the first round of $30 billion of payments from the HHS Provider Relief Fund as a result of the CARES Act, which was signed into law on March 27, 2020. All healthcare providers that received Medicare fee-for-service payments in 2019 should have received a payment.

The CARES Act Provider Relief Fund: What We Know So Far…

The CARES Act that was signed into law of March 27, 2020 provides for the Provider Relief Fund, which set aside $100 billion in relief funds for healthcare providers with expenses or lost revenue attributable to COVID-19. On April 9, 2020, the Department of Health and Human Services (“HHS”) released the first round of $30 billion of funding. All healthcare providers that received Medicare fee-for-service reimbursements in 2019 should have received a distribution. Payments will be made via electronic payment. Providers that do not receive electronic payment will receive paper checks over the next few weeks.

Florida HB 607 - APRNs Can Now Admit, Care, Discharge Patients without Physician Oversight

On March 11, 2020, lawmakers in both chambers of the Florida legislature passed House Bill 607 — legislation which would allow advanced practice registered nurses, or APRNs, to single-handedly admit, care for, and discharge patients from medical facilities. This would effectively eliminate the need for physician oversight, a costly expense for independent nurse practitioners.

BMD COVID-19 Healthcare Provider Resource Guide

Providers - for the latest information related to Medicaid/Medicare, Telehealth, HIPAA, CPT Codes, as well as Ohio and Federal Information, click here for a comprehensive resource guide to navigating during the Coronavirus pandemic.

CLIENT ALERT UPDATE: AHCA License Alert

IMPORTANT UPDATE: AHCA updated its website to clarify that all Behavior Analysis (“BA”) Groups have either (1) a health care clinic license or (2) an exemption from licensure as a health care clinic under Fla. Stat. 400.9905(4)(g) by December 1, 2020. Florida Medicaid has also updated Section 9.5, Appendix E of the Florida Medicaid Enrollment Policy, which confirms the December 1, 2020 date. This date extends the previously published date from July 1, 2020 to December 1, 2020.

Amanda L. Waesch recognized by NSCHBC at 2019 Annual Meeting

At this year's National Society of Certified Healthcare Business Consultant's Annual Meeting held St. Louis, Missouri, Amanda L. Waesch was awarded the Lenny Schwartz Go-Getter Award.

Amanda L. Waesch 2019 Recipient of the ATHENA Akron Award

Amanda L. Waesch received the ATHENA Akron award recognizing women leaders new to their posit