News

A big change was the reimbursement of audio only telehealth which also applies retroactively to March 1, 2020:CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

“The main driver here is our consumer expectation that what we’re getting in healthcare isn’t matching up to what we’re getting in other aspects of our lives,” he said. “The patients have a right to that data, for the patients to control and move as they desire, rather than under the control of the providers and payers.”

Topol said real-world evidence drawn from computerized records of COVID patients, while not as reliable as a clinical trial, is still very useful to help guide medical decisions.Medical data has been hard to tease out because much of it resides in electronic silos, which government officials have not required technology companies to open up and eliminate.

Specifically, the final rules call for payers to provide healthcare data to patients through the use of FHIR-based APIs, as well as using a similar methodology to make provider directories available to patients. The CMS rule mentions two implementation guides developed by the Da Vinci Project “that support the policies that we have finalized in this rule,” she said.“While these implementation guides are not requirements of the rule, we believe they will significantly support and improve the implementation of these APIs on the part of payers,” Mugge added.Implementation guides are standardized codes and approaches that give organizations across the healthcare industry a specific way to use FHIR to achieve certain capabilities.

OIG Information Blocking Enforcement Proposed RuleThe largest news is probably that coming out of OIG related to the previously announced Information Blocking Rule in the 21st Century Cures Act. This proposed rule would outline the civil money penalties OIG can enforce against those in healthcare who are doing what ONC has termed Information Blocking.In other words, this is the proposed enforcement of the 21st Century Cures Act Information Blocking provisions. You can read the proposed information blocking rule from OIG that is published on the Federal Register.

The use of telemedicine and remote care services are critical to the safe management of the COVID-19 pandemic, while also ensuring uninterrupted care for 100 million Americans with chronic conditions. Telemedicine spans a continuum of technologies that offer new ways to deliver care including:Real-time, audio-video communication tools (telehealth) that connect physicians and patients in different locations.Store-and-forward technologies that collect images and data to be transmitted and interpreted later.Remote patient-monitoring tools such as blood pressure monitors, Bluetooth-enabled digital scalesand other wearable devices that can communicate biometric data for review (which may involve the use of mHealth apps).Verbal/Audio-only and virtual check-ins via patient portals, messaging technologies, etc.

Grants, Contracts, And Other Agreements: Fraud and Abuse; Information Blocking; Office of Inspector Generals Civil Money Penalty Rules

OCR has reviewed the complaint and determined that, as a recipient of HHS funds, Pennsylvania is required to comply with the civil rights statutes listed above. OCR has been in communication with PDH, which has agreed to accept technical assistance from OCR and has revised its CSC Guidelines by:removing criteria that automatically deprioritized persons on the basis of particular disabilities,requiring individualized assessments based on the best available, relevant, and objective medical evidence to support triaging decisions, andensuring that no one is denied care based on stereotypes, assessments of quality of life, or judgments about a persons worth based on the presence or absence of disabilities.

Inspectors found that Medicare Advantage insurers had added diagnoses for diabetes, heart disease and other conditions in 99.3% of chart reviews of patient information, even though they did not appear in records from doctors, hospitals or other medical providers. Insurers deleted incorrect diagnoses less than 1% of the time, they found.