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Asks that insurers waive prior authorizations for hospital transfers, pay for telephone-only E/M services at the same level as in-person visits

April 3, 2020 (ACP) – This week the Centers for Medicare and Medicaid Services (CMS) issued new guidance about changes being made to help physicians and their practices as the country copes with the novel coronavirus (COVID-19) pandemic. The �������ý (ACP) also issued a call to all payers to consider waiving prior authorizations and other impediments to patient care during the national emergency.

The guidance from CMS was all about implementing provisions of the Coronavirus Aid, Relief, and Economic Security (CARES) Act that was passed by Congress last week.

Among the changes announced, CMS will begin paying physicians for patient visits that take place by audio telephone only. Previously, virtual visits were only paid for if both audio and video feeds were used.

“We are glad that CMS heard our concerns about physician practices. The changes announced by CMS yesterday will help practices by providing them with revenue to keep their practices open as they move away from in-person visits to virtual ones,” said ACP President Dr. Robert McLean. “The change to allow Medicare to begin paying for telephone visits is particularly important. This will benefit the many Medicare patients who only have landline or audio-only phones. It's critical that we continue to treat those patients while keeping them home as much as possible while we're facing the threat of COVID-19.”

CMS will now also allow for remote patient monitoring to monitor a patient's oxygen level using a pulse oximeter. Additionally, physicians and other health care professionals will be allowed to be paid in advance by Medicare for claims for services expected to be submitted later in the year, as ACP has recommended to CMS on multiple occasions.

“While these recent changes are a step in the right direction, more still needs to be done,” continued Dr. McLean. “Now more than ever our patients need to be able to access their personal physicians. CMS and others need to do what they can to ensure physicians and their practices are able to continue to care for them.”

In addition to the changes from CMS, the CARES Act contains other provisions that may help physician practices. The Small Business Administration will be making available loans to small businesses who need help to pay their employees in the short-term. ACP has been pulling together information about all of the different changes that could help physicians in private practice and is posting it to the Practice Management section of the website.

ACP has also been continuing to advocate for more to be done to help practices. In a series of letters sent earlier this week, they are calling on commercial insurers to make changes to alleviate some of the strain physicians are currently facing in running their practices.

“This is a pretty bold ask,” admitted Shari Erickson, ACP vice president of governmental affairs and medical practice. Prior authorizations and the hurdles involved with seeking and getting approval from payers has always been a pain point for physicians, and the COVID-19 crisis has worsened the situation. “Now some hospitals are waiting on prior authorizations to discharge patients who need to go to nursing homes,” Erickson said.

This is concerning given predicted shortages of hospital beds, she added. In letters to commercial insurance companies and other organizations, ACP asked that all prior authorizations for post-acute and hospital transfers be waived and that payers consider waiving all prior authorization requirements for the duration of the national emergency.

The letters, which went out to United Healthcare, the Blue Cross Blue Shield Association, America's Health Insurance Plans, the National Governors Association, the National Association of Insurance Commissioners, and the National Association of Medicaid Directors, also pointed out that some insurers are paying significantly less for telephone-only evaluations and management services than in-person visits. “This has to change,” Erickson said.

ACP is asking that these codes be paid at the same level as in-person visits during the pandemic. Many seniors may not know how to use FaceTime or Skype even if they even have smartphones, which limits their ability to participate in telehealth visits requiring two-way video. “The patient population who needs access to extended audio only visits are often the elderly and most vulnerable to COVID-19 should they be exposed,” Erickson said. “They need to stay at home and unfortunately are also isolated from family members who could help them implement more advanced technology.”

ACP also called on payers to allow physicians to waive copays for all types of telemedicine services – which Erickson said may encourage more patients to seek care. ACP asked payers to waive fees associated with the credentialing process, establish toll-free hotlines to enroll and receive temporary billing privileges, and temporarily postpone all revalidation efforts. These efforts will eliminate physician burden during the crisis and allow them to better care for more patients.

“We need to ensure that physicians are able to focus all of their attention right now on fighting COVID-19,” Dr. Robert McLean, ACP president, said in a news release. “We appreciate what insurers have done so far to help reduce burdens on physicians, and we ask for these additional steps to help physicians and other health care professionals devote their time to patient care and not to worry about administrative tasks.”

The Medicare Access and CHIP Reauthorization Act shifted physician payment so that it rewards value and quality over volume via the creation of the Quality Payment Program (QPP). The QPP offers two pathways for reimbursement: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. ACP is asking that deadlines be extended to report for value-based payment programs and that physicians and other clinicians participating in these plans be held harmless for 2020.

“Payment penalties should be waived, and participating physicians should be able to postpone reporting,” Erickson said. “The data will also be skewed as the patients that internists are seeing, whether they have COVID-19 or not, are likely going to be much sicker so it may not be an adequate reflection of care.”

More Information

ACP encourages physicians to continue checking the ACP website for updates on coding and administration during the COVID-19 pandemic. A summary of the recent changes from CMS is available on the ACP website. In addition, updated guidance for practices, including information about the Payroll Protection Program that will provide loans to small businesses, can be found on the ACP website.

Back to the April 3, 2020 issue of ACP Advocate