PYA Principal Martie Ross was recently quoted in the Report on Medicare Compliance article, “PHE and Many of Its Waivers Will End May 11, Ushering in Uncertainty, Compliance Risk.”
After almost three years, the PHE is ending. Among many uncertainties and unintended consequences are questions surrounding the three-day qualifying stay for skilled nursing facilities (SNFs) and Medicare reimbursement. Ross cites the loss of that waiver in the absence of CMS guidance as a big concern because of the effect on hospitals, SNFs, and patients.
“CMS will have to come out and say it’s OK as long as you came in during the PHE,” Ross notes. “That could be a mess. That’s the obvious one that we need CMS to step in on.”
Another area of concern involves changes to telehealth. Medicare has been paying for telehealth services delivered by physicians at the higher nonfacility rate during the PHE instead of the lower facility rate it paid pre-pandemic. In the final 2023 MPFS rule, CMS said it would continue to pay the higher nonfacility rate for 151 days after the end of the PHE. Ross says whether CMS will continue to do so now that Congress again extended many telehealth services is another unanswered question.
Read the full article on the Health Care Compliance Association’s online platform, COSMOS. Access a PDF here.
Martie, along with PYA Senior Manager Kathy Reep, will give a webinar on the end of the PHE on March 1, 2023. Learn more.
If you have questions about the effects of the end of the PHE on healthcare organizations and reimbursement, one of our executive contacts would be happy to assist. You may email them below, or call (800) 270-9629.