Telehealth, DME, Federal Assistance for DPMs

and COVID-19

Josh White, DPM, CPed8 April 2020

WHAT’S CHANGED

• Telehealth• DMEPOS Compliance Changes• Audits• Enrollment / Revalidation• DMEPOS Accelerated / Advanced Payment• Federal Assistance for Physicians and their Practices• Small Business Relief

Telehealth

Telehealth

• NOT required that telehealth be initiated by patient• HIPAA rules won’t be enforced• Means real-time, audiovisual chat• Can use FaceTime, Skype• Need NOT only be for rural patients• E&M codes: 99201 – 99205

99212 – 99215• Use 95 modifier• POS: 11, office

32, nursing facility

DME Lost, Destroyed, Irreparably Damaged or Rendered Unusable

• DME MACs have the flexibility to waive usual requirements• Face-to-face not required for prescription• New physician’s order• New medical necessity documentation• Must include narrative description of why equipment must be

replaced and include that occurred during emergency

Signature Requirements

• Waiving signature and proof of delivery requirements for DME• Document the date of delivery • Document that signature not able to be obtained because of

COVID-19• More relevant for wound care than AFO, shoes

Diabetic Shoes

• CANNOT dispense shoes with custom inserts to patients remotely without signature as LCD requires “face-to-face visit” to evaluate fit.

• CANNOT dispense shoes with prefabricated inserts as A5512 need to be heat molded to feet

• Shoes not allowed to be dispensed without inserts.

Diabetic Shoes

• Consider potential liability if patient not using device correctly.• NOT allowed to tell patients with diabetes that they are entitled to a

new “free” pair shoes. • CAN advise that if they have certain conditions that they may

qualify for shoes that may entail no out of pocket cost.

Diabetic Shoes, Repeat Orders: Patient Receipt

Diabetic Shoes

• MD could provide diabetes management via telehealth, as required within 6 months prior to dispensing shoes, if bill as 99201-15.

• DPM could conceivably perform telehealth CDFE to (re)qualify patient for shoes if determined there to be structural change (iebunion, hammertoe). Could be difficult to remotely, objectively determine decreased circulation or decreased sensation.

• For shoes already dispensed, billing for follow-up visits included in payment for device

AFOs

• CANNOT dispense to patient remotely as LCD requires “face-to-face visit” to evaluate fit

• Could conceivably perform telehealth biomechanical evaluation to (re)qualify patients to prescribe.

LCD Requirement for AFOs

LCD Requirements for Custom AFOs

CMS Suspends Medical Reviews

Pre-Payment Targeted Probe and Educate (TPE)• Reviews in process will be suspended and claims paid

Post-Payment SMRC, MAC and RAC reviews• Suspended and released from review

Redetermination, Reconsideration, ALJ

Extension of time to reply• CMS directing MACs to allow DPMs up to 14 additional

calendar days to respond, if requested

Use of “flexibility” in the appeals process• CMS allowing MACs to utilize all flexibilities as if good cause

requirements are satisfied

DME Supplier Enrollment, Revalidation

• Expediting pending and new applications. o clean web applications processed 7 business days o clean paper applications processed 14 business days

• Pending applications received prior to March 1, 2020 processed as usualoWeb applications are processed within 45 days oPaper applications within 60 days.

DME Supplier Enrollment, Revalidation

• Waived for all enrollment applications received on or after 3/1/20: oApplication Fee, $595 oCriminal background checksoSite-visitsoPostpone all revalidation actions

Accelerated and Advance Payments Program

• Goal is to increase supplier cashflow• CMS authorizes MACs to accelerate processing claims submitted

and making payment within 7 days.• CMS authorizes MACs to make advance payments up to 100%

of the amount billed for three months.• MACs instructed to review and issue payments within 7 days.• Repayment to begin 120 days after issuance of payment and to be

completed by 210 days.

Accelerated and Advance Payments Program

• Accelerated / Advance Payment Request Forms on each MAC’s website.oCheck box 2 (“Delay in provider/supplier billing process of an

isolated temporary nature beyond the provider’s/supplier’s normal billing cycle and not attributable to other third-party payers or private patients.”)

oState that request for an accelerated/advance payment due to the COVID-19 pandemic.

Federal Assistance for Physicians and their Practices

$100 billion to provide direct aid to health care institutions on the front line of this crisis – hospitals, public entities, not-for profit entities, and Medicare and Medicaid enrolled suppliers and institutional providers – to cover costs or lost revenue related to the public health crisis

Relief for Physicians

Section 3213. Rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs. • Reauthorizes HRSA grant programs to strengthen rural community

health by focusing on quality improvement, increasing health care access, coordination of care, and integration of services.

Section 3513. Temporary Relief for Federal Student Loan Borrowers • Defer federal student loan payments, principal, and interest for 6

months, through September 30, 2020, without penalty.

Relief for Physicians

Section 3709. Increasing Provider Funding through Immediate Medicare Sequester Relief • Temporarily lifts Medicare sequester, which reduces payments to

providers by 2%, from May 1 through December 31, 2020

Small Business Relief, PPP

Paycheck Protection Program (PPP)Loan Amount:• Up to two months of average monthly payroll costs from last year

plus additional 25 percent of that amount • Payroll costs will be capped at $100,000 annualized for each

employee• Loan cannot exceed $10 million dollars

Small Business Relief, PPP

Paycheck Protection Program (PPP)Loan Forgiveness:• Forgiven if funds are used for payroll costs, interest on mortgages,

rent, and utilities • Reduced if full-time headcount is reduced.• Reduced if decrease salary and wages by more than 25 percent of

any employee who made less than $100,000 in 2019.Loan Terms:• .05% interest• Due in two years• Payments deferred for two months

Small Business Relief, EIDL

Economic Injury Disasters Loan and Loan Advance (EIDL)• Offers entities who have applied for EIDL loan to request a $10,000

advance on that loan; • SBA must distribute within 3 days. • Not required to repay advance payments, even if subsequently qualify

for, but denied, EIDL loan. • Advance payment may be used for providing paid sick leave to

employees, maintaining payroll, meeting increased costs to obtain materials, making rent or mortgage payments, and repaying obligations

Small Business Relief

Section 230. Employee retention credit for employers subject to closure due to COVID-19 • Provides a refundable payroll tax credit for 50 percent of wages paid

by employers to employees.

Section 2302. Delay of payment of employer payroll taxes • Defer payment of the employer share of the Social Security tax

APMA

SUMMARY

• Telehealth• DMEPOS Compliance Changes• Audits• Enrollment / Revalidation• DMEPOS Accelerated / Advanced Payment• Federal Assistance for Physicians and their Practices • Small Business Relief