CMS recently released their quarterly update of the Hospital Outpatient Prospective System and clarified their policy regarding the applicability of modifier FY when images were performed using both CR and DR technology (multiple views). Modifier FY is to be reported when CR technology is the only technology used to perform the imaging service. If an imaging service has both CR and DR views, then the payment adjustment does not apply and modifier FY does not need to be used. AHRA urged CMS to provide clarification on these types of scenarios and we are pleased to see that they have clarified the policy. Here is the relevant language from the quarterly update (emphasis added):

CMS notes that section 1833(t)(16)(F)(ii) refers to an imaging service that is an X-ray taken using computed radiography technology. Where the imaging service is comprised of multiple images that include both X-rays taken using computed radiography technology and images taken using digital radiography, CMS does not believe the payment reduction would apply to that service. Instead, the payment adjustment applies to an imaging service that is an X-ray taken using computed radiography technology where the X-ray taken using computed radiography technology is not combined with digital radiography in the same imaging service.

This “CR to DR” policy was created by the Consolidated Appropriations Act of 2016 and it reduces Medicare reimbursement for X-rays taken using computed radiography technology by 7% until 2022 and 10% thereafter. The intent is to incentivize a transition to digital radiography technology and save Medicare money. The Consolidated Appropriations Act of 2016 also reduced Medicare reimbursement for film X-rays by 20%. If you perform an X-ray with film, you must use modifier FX.

Lamar Alexander (R-TN), Chairman of the Senate Health, Education, Labor and Pensions Committee, believes that certain temporary federal telehealth policies should be made permanent. Chairman Alexander is focused on three main changes; provider reimbursement regardless of the originating site, Medicare and Medicaid reimbursement for telehealth services, and providing telehealth services through common apps like FaceTime or texting.
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Results from a University of Oxford study showed that Dexamethasone, a commonly used steroid, reduces death in severe COVID-19 patients by up to one third. Scientists around the world are cautiously optimistic about the study but are remaining skeptical until they can review the research data.
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The Department of Health and Human Services (HHS) announced a new Provider Relief Fund distribution of $15 billion dollars to Medicaid providers who did not receive funding from the Provider Relief Fund’s General Allocation. HHS is also distributing $10 billion to safety net hospitals.
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The White House Coronavirus Taskforce does not see a link between an increase in Coronavirus cases and states reopening, but there are worries of a spike in COVID-19 cases related to ongoing protests in all 50 states.
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National Institute of Allergy and Infectious Disease (NIAID) Director, Dr. Anthony Fauci believes the U.S. will have at least 100 million COVID-19 vaccines before the end of the year. He also believes we will have a few hundred million more vaccines by the beginning of 2021.
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The Department of Health and Human Services (HHS) is reminding providers of the June 3rd deadline to submit their cost report data for the second distribution from the Provider Relief Fund’s General Allocation. HHS is distributing $20 billion under this second distribution.
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The Centers for Medicare and Medicaid Services (CMS) published a new fact sheet to help state and local governments developing “alternate care sites” understand how to seek payments through CMS programs (Medicare, Medicaid and CHIP) for acute inpatient and outpatient care furnished at the site. Alternate care site is a broad term for any building or structure that is temporarily converted or newly erected for healthcare use.
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Several prominent Republicans began discussing the party’s priorities for the next COVID-19 relief bill. White House Chief Economic Advisor Larry Kudlow said President Trump might support a “back to work bonus.” This bonus could replace or supplement the temporary increase to unemployment benefits. Versions of this proposal have been introduced by Republicans in the Senate. They believe maintaining the increased unemployment benefits could incentivize unemployed people to refrain from seeking employment.
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