Policy Statements

CMS Releases Updated Rules on Payer Transparency and Pricing On October 29, CMS finalized its Transparency in Coverage rule. The final rule is part of a larger effort to ensure price transparency across the healthcare sector. The Transparency in Coverage rule moves to require significant public disclosures of the prices of items and services by private health insurers. The final rule has two key components: Requires group health plans and health insurance issuers in the individual and group markets to disclose to all participants/beneficiaries/enrollees cost-sharing information for covered items and services. This requirement will be phased in, with cost-sharing information for 500 “shoppable” services to be provided starting January 1, 2023, and cost-sharing for all items and services to be provided […]

New CPT Code for Costs Related to COVID-19 and Advocacy to Urge Payers to Provide Coverage On November 7, the AMA Current Procedural Terminology (CPT) Editorial Panel announced the approval of CPT code 99072 to be used to report the additional supplies, materials, and clinical staff time over and above the practice expense(s) included in an office visit or other non-facility service(s) when performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease. To help address the significant fiscal pressures placed on physicians by the COVID-19 pandemic, the AMA and other associations, including ISASS, submitted multiple letters urging the CMS, America’s Health Insurance Plans, Blue Cross Blue Shield Association, and major commercial health plans (i.e., Anthem, […]

Study Published on Medicare Utilization and Spending During COVID-19 Crisis On October 8, 2020, the Department of Health and Human Services published a study on Medicare utilization and spending in 2020 to analyze utilization and spending trends during the COVID-19 Emergency. The study, which was conducted by the Assistant Secretary for Policy and Evaluation Office of Health Policy, reported several key findings, including: Medicare beneficiary utilization of services declined substantially beginning in mid-March 2020, bottomed out the week ending April 8, and increased through June. Payments for all fee-for-service claims declined by 39% in the week ending April 8—33% for inpatient services and 49% for physician services. By the week ending July 1, weekly payments had nearly returned to 2019 […]

CMS Announces New Repayment Terms for Medicare Loans Made to Providers During COVID-19 On October 1, 2020, the Department of Health and Human Services (HHS) announced that it will be disbursing another $20 billion in CARES Act Provider Relief Funds. Under this Phase 3 General Distribution allocation, physicians who have already received Provider Relief Fund payments may apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. The negative impact of the COVID-19 pandemic has increased anxiety and depression in the country, and behavioral health providers have continued to provide care through telehealth and other means. Thus, HHS is also announcing that the nation’s behavioral health care providers, including psychiatrists, are now eligible for funding. Previously […]