April 2021 Client Newsletter
HHS Public Health Emergency (PHE) Extended
Alex Azua, Secretary of HHS, has extended the Public Health Emergency (PHE) another 90 days to April 21st. That means that many of the copays will continue to be paid by insurers.
NJ Medicaid Re-Enrollment Starting
NJ Medicaid will begin conducting provider re-enrollment in April 2021, as required by Federal law. Re-enrollment, also known as re-validation, is required of all Medicaid providers every five years.
The re-enrollment process will be completed by provider type in monthly stages and providers will receive written notice from Gainwell Technologies (NJ Medicaid’s fiscal agent) 30 days prior to receiving a re-enrollment packet. Each re-enrollment application packet will include a cover letter with a mandatory return date and each packet will include the required forms and documentation required.
If any client that participates with NJ Medicaid receives a re-enrollment packet, please notify Robin right away. NJ Medicaid doesn’t specify which month a particular provider type will be sent the re-enrollment application. Just that this process is starting April 2021.
COVID-19 Cost Share Waiver’s
Per United Healthcare and Aetna - COVID 19 treatment cost share is waived until 3/31/21 for all visits. Seems to also be true for the UHC & Aetna Medicare AAdvantage plans. Telemedicine for UHS & Aetna appears to also end March 31st.
Horizon for COVID co-pay waived thru 6/30/21 but does NOT include the self-insured plans (collect those copays). Horizon will continue to waive copays for telemedicine until at least 90 days beyond the end of the Public Health Emergency (federal PHE) & State of Emergency declared by the governor.
RPM & CCM
We now have one forward-thinking client doing Remote Physiologic Monitoring (RPM) and another still considering. Devices that can be used include automated blood pressure cuffs, glucometers, scales, oximeters, etc. Medicare will pay you for the equipment and the time to manage the patient.
WARNING (effective 3/8/21): Horizon is NOT paying well at all. We do NOT advise including any Horizon patients in RPM at this time.
Chronic Care Management (CCM) is another opportunity to add a service for patients with 2 or more chronic conditions expected to last 12 or more months.
For both programs, the actual calls can be handled by your clinical staff (includes RN’s, LPN’s, medical assistants, Registered Dieticians, etc.) with your supervision.
AND, both are billable the same month. For patients who qualify, the above 2 programs can make a positive difference to their health – and your revenue!
Horizon & Virtual Credit Cards (VCC) vs. EFT
Given Horizon’s sudden change to pay using VCC’s, if you do not accept credit cards, or do not want to pay the unconscionable fee to use VCCs, you can contact NaviNet to transition to EFT.
Medicare COVID-19 Vaccine Shot Payment
“On March 15, 2021, CMS is updating the Medicare payment rates for COVID-19 vaccine administration. Effective for services furnished on or after March 15, 2021, the new Medicare payment rate for administering a COVID-19 vaccine will be approximately $40 to administer each dose of a COVID-19 vaccine. This means that starting on March 15, 2021, for single dose COVID-19 vaccines, Medicare will pay approximately $40 for its administration. Starting on March 15, 2021, for COVID-19 vaccines requiring multiple doses, Medicare will pay approximately $40 for each dose in the series… The rate will be geographically adjusted based on where the service is furnished...
For COVID-19 vaccine administration services furnished before March 15, 2021, the Medicare payment rate for a single-dose vaccine or for the final dose in a series is $28.39. For a COVID-19 vaccine requiring a series of two or more doses, the payment rate is $16.94 for the initial dose(s) in the series and $28.39 for the final dose in the series. These rates are also geographically adjusted.
Note: these rates do not apply for entities that are paid for preventive vaccines and their administration at reasonable cost…
Get the most up to date list of billing codes, payment allowances and effective dates.
There’s no cost for your patients.
People with Medicare pay nothing for COVID-19 shots:
- No copayment/coinsurance
- No deductible