Rhode Island Medical Society
Executive Orders 20-06 Fourth Supplemental Emergency Declaration - Expanding Access To Telemedicine Services
Payer's Guidance for Physicians
The Center for Medicaid and Medicare Services (CMS) released their 2020 Medicare Learning Network Telehealth Services Booklet. The Booklet contains the updated Medicare telehealth policies for 2020 as well as a special alert on the changes made in response to COVID-19.
Blue Cross & Blue Shield - Payment Policy - Temporary Telemedicine/Telehealth Services Provided Via by Phone Only
OHIC - Rhode Island Office of the Health Insurance Commissioner & Medicaid Program Instructions During the COVID-19 State of Emergency
United Healthcare - No Cost share for COVID-19 testing and testing related visits
United Healthcare - Expanded Provider telehealth access
United Healthcare - Updated diagnosis and laboratory codes
General COVID 19 Resources for Practices from Assorted Organizations
RIDOH State Health Laboratories Test Requisition Form - to order testing for patients in the following high-risk categories at the RISHL
RIDOH COVID-19 Testing for Symptomatic People - describes the process that healthcare providers should follow to order COVID-19 tests for their patients
American College of Emergency Physicians Social Media
Instagram (must share a message to get access)
AMA CMS COVID-19 Coverage and Reimbursement Facts
Coverage and Reimbursement
CMS Fact Sheet on Medicare telehealth
CMS FAQs on Medicare telehealth
CMS chart on Medicare telehealth
CMS guidance on Medicaid telehealth
CMS state guidance on Medicaid telehealth
AMA Guidance for Ethical Practice in Telemedicine
Healthcare providers must place an order for COVID-19 testing at a Drive-up Specimen Collection Site by completing an East Side Clinical Laboratory order form (fillable form or downloadable form). Completed forms can be emailed to firstname.lastname@example.org or faxes to 401-208-041.
The Office of the Health Insurance Commissioner (OHIC) has prepared the attached new “Provider FAQs” in response to questions submitted to OHIC by the Rhode Island Medical Society.
OHIC Commissioner Marie Ganim, PhD, tells RIMS further, “We continue to work with the insurers to resolve remaining issues that are being raised, or that we have not yet resolved. As a result, this is Part One, and we expect to update it each week. It is posted on OHIC’s website and the RIDOH site also.”
Resources for Out of State Physicians to Treat RI Patients
Here is RI’s 1135 Medicaid waiver allowing RI to waive prior auth, extend existing prior auths, extend fair hearing and appeal deadlines, and liberalize provider enrollment. The waiver is dated March 25, retroactive to March 1, and in force as long as the emergency is in force.
A letter to President Trump - Social Distancing
Rhode Island Medical Society, Physicians Support Gov. Raimondo's Order Asking All Rhode
Islanders Stay Home to Limit Spread of COVID-19
OHIC Provider FAQ - April 9, 2020
Joint Statement - Roadmap for Resuming Elective Surgery after COVID-19 - April 17, 2020
HHS Provider Relief Fund Clarifications
AMA has received many questions from physicians and medical societies related to the CARES Act Provider Relief Fund, and we have been in touch with senior HHS officials about them. Certain formulas that were previously on the HHS website led some physicians to believe they may have received more money from this fund than they were supposed to and they were worried that it will be recouped by HHS. Because the AMA informed the administration of the concerns and alarm the previous formulas and language about overpayments were causing many physicians, HHS removed it from the website.
HHS was concerned that many physicians were using the formulas to calculate for themselves what they thought HHS intended for them to receive from the CARES Act Provider Relief Fund, and then deciding on the basis of their own calculations that they were going to be in trouble. HHS has asked for people to provide documentation of certain revenue information so that it can make the calculations specific to each TIN (Taxpayer Identification Number). HHS removed the formula and overpayments language from the portal last week to allay concerns from physicians who had done their own estimates and reached conclusions about potential overpayments instead of relying on HHS to do the calculations. Unfortunately, in some cases these changes with formulas appearing and disappearing from the website heightened rather than allayed concerns. On Friday, May 15th, HHS posted revised FAQs on the Provider Relief Fund General Distribution Portal:
Several of the FAQs are dated May 14th, and seek to clarify some of the recent confusion, particularly these two questions:
How did HHS determine the additional payments under the General Distribution? (Added 5/14/2020)
HHS is distributing an additional $20 billion of the General Distribution to providers to augment their initial allocation so that $50 billion is allocated proportional to providers' share of 2018 net patient revenue. The allocation methodology is designed to provide relief to providers, who bill Medicare fee-for-service, with at least 2% of that provider’s net patient revenue regardless of the provider’s payer mix. Payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April. If the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you will not receive additional General Distribution payments.
How can I estimate 2% of patient revenue to determine my approximate General Distribution payment? (Added 5/14/2020)
In general, providers can estimate payments from the General Distribution of approximately 2% of 2018 (or most recent complete tax year) patient revenue. To estimate your payment, use this equation:
(Individual Provider Revenues/$2.5 Trillion) X $50 Billion = Expected Combined General Distribution.
To estimate your payment, you may need to use “Gross Receipts or Sales” or “Program Service Revenue.” Providers should work with a tax professional for accurate submission.
This includes any payments under the first $30 billion general distribution as well as under the $20 billion general distribution allocations. Providers may not receive a second distribution payment if the provider received a first distribution payment of equal to or more than 2% of patient revenue.
Additional information that has recently been added notes that HHS is making a list publicly available of the providers who have received and accepted money from the Provider Relief Fund here: https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6
Other questions have arisen regarding what HHS views as the appropriate use of the CARES Act funds. We have not seen additional guidance beyond that provided on the website and we think it would be difficult for HHS to craft language in a way that would be relevant to each practice’s individual needs. We believe that the key thing is that each practice is able to clearly document the revenue losses and expenses it is incurring that are directly due to COVID-19, which could include losses related to social distancing (such as cancellation of visits and procedures, Part B drugs that have passed their expiration date), costs of new infection control practices, PPE, digital health equipment, etc., and that are not reimbursable from other sources (excluding loans that have to be repaid).
Providence Marriott Downtown Special Rate for Healthcare Professionals
Please note also that this grid is a compilation assembled by volunteers for the benefit of the community and is intended as a handy reference for clinical practices. It is not an official document of the Department of Health, the Office of the Insurance Commissioner, or any specific health plan. For official current payer policy, please contact the payer.
Support for Healthcare Workers
Care New England/Lifespan Support Hotline for ANY healthcare worker: 401-606-6000
National Physician Support Line: 888-409-0141 (8:00 AM to 3:00 AM next day EST)
The Physician Support Line was created in March to provide confidential peer-to-peer support for MD’s/DO’s working on the frontlines of COVID-19. The Line is staffed by over 700 volunteer psychiatrists from across the country seven days per week.
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American Medical Association HHS letter relating to CARES Act Emergency Fund