Yesterday, CMS issued some well-needed clarity on the No Surprises Act (NSA) through six FAQs on the topic of Good Faith Estimates (GFE) put into effect for all providers as of January 1, 2022. As previously published by the FCA, the NSA was created to provide additional protections against surprise medical bills, including:

• Requiring good-faith estimates of medical items or services for uninsured (or self-paying) individuals.
• Requiring notice posted in your office and on your website of the uninsured/self-insured’s right to receive a good faith estimate.
• Establishing a patient-provider dispute resolution process for uninsured (or self-paying) individuals to determine payment amounts due to a provider or facility under certain circumstances.

Have you received your Comparative Billing Report (CBR)?

Several FCA members have recently reported to the FCA’s Help Desk that they received a CBR from Medicare. The CBR, Comparative Billing Report, identifies that provider’s Medicare activity based on bills submitted in 2017, 2018 and 2019.

 The Chiropractic Medicare Coverage Modernization Act (H.R. 2654), legislation that would ensure that Medicare beneficiaries have full access to all the services a chiropractor can provide under his or her state’s chiropractic scope of practice, was introduced in the U.S. House of Representatives on April 19, 2021. 

President Biden has signed S. 610, the “Protecting Medicare and American Farmers from Sequester Cuts Act,” which delays the Medicare sequester, makes changes to Medicare payments, and modifies procedures affecting federal budget scorekeeping and federal borrowing.

What do you need to do about Medicare to have a smooth transition to 2022?  Review these pointers to stay on top of year-end Medicare concerns.

Medicare Participation Status may be changed once a year, if postmarked before January 1st.

CMS has approved the updated ABN form with an expiration date of 6/30/2023.  The deadline date for use of this updated form, originally mandated by August 31, 2020, has been extended to 10/14/2021 due to the pandemic. The renewed form may be implemented prior to the mandatory deadline. Read on for links to the form, instructions and important clarifications.

Medicaid Claims will Deny if a Referring, Ordering, Prescribing, or Attending Provider is Not Enrolled IN Medicaid

(From CMS Newsletter of March 30, 2021)  "In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess if Congress extends the suspension; the MACs will automatically reprocess any claims paid with the reduction applied if necessary." 

(From Modern Healthcare)  The U.S. Senate voted Thursday to delay Medicare payment cuts for the rest of the year, a big win for hospitals and providers.   The 2% cuts originally took effect in 2013 but were paused by Congress last year in response to the pandemic and its effect on providers' finances.  The cuts totaling $18 billion were scheduled to resume next week absent Congressional action.

The legislation still needs consideration by the House.  Please stay tuned for more news and potential calls to action.  Profound thanks to all FCA members who reached out to Senators Rubio and Scott through this past week's email campaign posted on the FCA website.