CMS relaxes rules to create practice, financial relief
This week, the Centers for Medicare and Medicaid Services (CMS) announced additional regulatory and financial relief for physicians as part of its response to the COVID-19 pandemic. The regulatory changes, summarized in this CMS Flexibilities Fact Sheet are designed to increase hospital capacity, expand the health care workforce, relax reporting requirements and further promote telehealth.

Increasing hospital capacity
To support increased hospital capacity, CMS is allowing health care systems and hospitals to provide services in locations beyond their existing walls to help address the urgent need to expand care capacity and to develop sites dedicated to COVID-19 treatment.

Under CMS’s new temporary rules, hospitals will be able to transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels and dormitories, while still receiving hospital payments under Medicare. The rules also permit ambulatory surgical centers to contract with local health care systems to provide and bill for hospital services, allow doctor-owned hospitals to increase the number of their beds without incurring sanctions and add flexibility for testing and emergency treatment.

Easing practice, payment requirements
To expand health care, CMS is rolling back barriers to practice and payment. The new rules make it easier for providers to enroll in Medicare, which will expand the number of enrolled practicing physicians and make it easier for those coming from other specialties and out of retirement. They also allow medical residents to provide services under the direction of a teaching physician, either in person or through audio/video. The rules also permit the use of verbal rather than written orders, so that physicians can focus on their patients.

The CMS rules also relax some reporting requirements on hospital and physicians. For example, CMS will continue its oversight activities but will suspend requesting additional information from plans, providers, and health care facilities. It’s also modifying the calculation of the 2021 and 2022 Part C and D Star Ratings to address the expected disruption to data collection and measure scores posed by the COVID-19 pandemic.

Finally, CMS is expanding access to telehealth services for people with Medicare. Rule changes include expanded coverage of services rendered through telehealth, including home health and hospice services, as well as allowing providers to evaluate patients through audio-only telehealth.

Expanding accelerated and advance payments
The Administration is also offering physicians financial support by expanding its accelerated and advance payment program for Medicare participating health care providers.

The accelerated and advance payment program expansion included in the $2 trillion CARES Act is one of many stop-gap financial assistance measures to lessen the impact of lost revenue. The program will provide expedited payments to health care providers and suppliers impacted by the COVID-19 pandemic.

To qualify for accelerated or advance payments, the provider or supplier must:
  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form.
  • Not be in bankruptcy.
  • Not be under active medical review or program integrity investigation.
  • Not have any outstanding delinquent Medicare overpayments.
Medicare will start accepting and processing the accelerated and advance payment requests immediately. CMS anticipates that the payments will be issued within seven days of the provider’s request. Additional information can be found in this CMS Accelerated and Advance Payment Fact Sheet.

Again, this is one of several programs aimed at providing financial relief for physicians. The CARES Act also includes the Paycheck Protection Program and Economic Injury Disaster Loans.