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July 2020 Client Newsletter

Verifying Insurance EVERY Visit

Long standing guidance – Front desk staff MUST verify each patient’s insurance at EVERY visit and EMT’s during each EMS transport.  This is true for all patients, all insurances.  Ask for a copy of the insurance cards. 

If their insurance is not current, the charges will be denied by insurance and the provider will not be paid.  Best case payment is delayed until the correct insurance is obtained, worst case not paid at all.  Get the insurance while you can look them in the eye!  ? 


Insurance Refunds

On June 13, 2020 Horizon announced that all refunds will now require a paper check – providers no longer can request an offset of future payments.  They state this is due to a ruling by the 8th Circuit Court.  This is likely to result in other insurers doing the same. 
As always, CPB will review the request and let you know if we agree.  If we do, we will forward the information to you so the check can be written & mailed.  We will then “Refund” it out of the patient’s account. 

If we disagree, we will address it with the insurer.


Updated PPP forgiveness guidance released

The Small Business Administration (SBA) released further guidance on Paycheck Protection Program (PPP) loan forgiveness. The Interim Final Rule updates previous loan forgiveness guidance to reflect the changes made under the recently enacted Paycheck Protection Program Flexibility Act. In the guidance, SBA clarifies that a borrower may submit a loan forgiveness application before the end of the covered period if he or she has used all the loan proceeds for which he or she is requesting forgiveness. For more information on the PPP, you can access MGMA’s recently updated resource.


New Medicare prior authorization requirements go into effect July 1

The Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule issued by CMS established nationwide prior authorization requirements for certain hospital outpatient department services.

The following Medicare services will require prior authorization when provided on or after July 1, 2020:

  • Blepharoplasty
  • Botulinum toxin injections
  • Panniculectomy
  • Rhinoplasty
  • Vein ablation

CMS is, however, removing HCPCS code 21235 (Obtaining ear cartilage for grafting) from the list of codes that require prior authorization as a condition of payment, as it is more commonly associated with procedures unrelated to rhinoplasty that are not likely to be cosmetic in nature. The full list of HCPCS codes requiring prior authorization is available here.  


2020 MIPS: Hardship exception available due to COVID-19

The Centers for Medicare & Medicaid Services (CMS) announced flexibilities for clinicians participating in the Merit-based Incentive Payment System (MIPS) in 2020. Clinicians significantly impacted by the COVID-19 public health emergency may submit an Extreme & Uncontrollable Circumstances application to reweight any or all of the MIPS performance categories by logging into their HARP account at If a group practice or individual clinician submits 2020 MIPS data for one or more performance categories, that data submission will override an approved application on a category-by-category basis.

2020 Client Newsletter Archive