June 10, 2020

The Department of Health and Human Services (HHS) Provides an Update on the Provider Emergency Relief Fund

On May 15, 2020, HHS posted revised FAQs on the Provider Relief Fund General Distribution Portal in response to many questions from physicians and medical societies related to the CARES Act Provider Relief Fund. Certain formulas that were previously on the HHS were used by physicians to calculate what they thought HHS intended for them to receive from the fund. Based on their calculations, many physicians though they received too much and that those funds would later be recouped by HHS. To allay these concerns, HHS removed the formula and overpayments language from the portal last week. Unfortunately, in some cases, the appearing and disappearing of the formulas from the website heightened rather than allayed concerns. Currently, HHS has asked […]
June 10, 2020

HHS Extends Deadline for Attestation, Acceptance of Terms and Conditions for Provider Relief Fund Payments to 45 Days

The HHS has extended the deadline for healthcare providers to attest to receipt of payments from the Provider Relief Fund and accept the Terms and Conditions. Providers will now have 45 days, increased from 30 days, from the date they receive a payment to attest and accept the Terms and Conditions or return the funds. As an example, the initial 30-day deadline for providers who received payment on April 10, 2020, is extended to May 24 from May 9, 2020. With the extension, not returning the payment within 45 days of receipt of payment will be viewed as acceptance of the Terms and Conditions. President Trump is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and Paycheck Protection Program […]
June 10, 2020

HHS CMS Releases Proposed Rule for Inpatient Prospective Payment System (IPPS) for 2020/2021

On May 11, the Trump Administration proposed changes for acute care and long-term care hospitals that build on the progress made over the past 3 years and further the agency’s priority to transform the health care delivery system through competition and innovation while providing patients with better value and results. The proposed rule would update Medicare payment policies for hospitals paid under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for FY 2021. CMS is proposing a separate new hospital payment category for Chimeric Antigen Receptor (CAR) T-cell therapy. CAR-T is the first-ever gene therapy, and it uses a patient’s own genetically modified immune cells to treat people with certain types of […]
June 10, 2020

ISASS Provides Extensive Additional Comments to Anthem on Sacroiliac Joint Fusion Coverage Policy During Call and Response Letter

On May 26, 2020, ISASS sent a comment letter to Anthem regarding their Sacroiliac Joint Fusion Coverage Policy, which is used in many states/regions by Anthem for fee schedule and coverage policies. The ISASS letter asked that Anthem revise their coverage policy to consider inclusion of coverage of minimally invasive sacroiliac joint fusion, which would be consistent with ISASS recommendations for appropriate criteria for sacroiliac joint fusion procedures and criteria on nonsurgical options. The May 26 letter was sent as a follow-up to a call on May 18, 2020, with ISASS Coding and Reimbursement Task Force Chair, Morgan Lorio, MD, and David Polly, MD, and the Anthem Coverage Policy team, led by John Whitney, MD. Read the ISASS 5-26-20 Anthem […]