CMS: More COVID-19 Policy Changes Announced

From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple, MD, FACG

On Monday, March 30th, the Centers for Medicare and Medicaid Services (CMS) announced a series of temporary waivers and policy changes for providers in order to improve access to care and mitigate the damage caused by COVID-19 across the country. Click here for the summary of provider changes. Of note to ACG members:

Telehealth: CMS is now allowing the use of telephone E/M services (CPT codes 99441-99443) for Medicare beneficiaries. These services are based on time and were previously non-covered services.

ACG President Mark B. Pochapin, MD, FACG this week urged CMS to extend waiver authority to allow ACG members to use the telephone for traditional E/M services as well. ACG members have voiced their concerns over this policy, as many Medicare beneficiaries are unwilling/unable to use video on cell phone or other devices. This change would also allow Medicare beneficiaries to stay at home.

Changes to MIPS: In addition to extending the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline to April 30, 2020, the MIPS “automatic extreme and uncontrollable circumstances” policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30 deadline.

Important Note for ACG Members: 

If you are an “MIPS-eligible” clinician and do not submit any MIPS data by April 30, 2020, you won’t need to take any additional action to qualify for this automatic extreme and uncontrollable circumstances exemption. You will be automatically identified and will not receive a cut in Medicare Part B reimbursement 2021 payment year for failing to participate in MIPS (you could receive a cut on certain services for other reasons).

Click here to read more about CMS’ announcements this week.

ACG Guidance: Economic Relief for GI Practices

From ACG Board of Trustees Member Carroll D. Koscheski, MD, FACG

ACG members are working admirably on the front lines of this COVID-19 crisis. We are also dealing with this crisis as small business owners, employing of many residents in our communities. The $2 trillion CARES Act sets up lending programs administered through the Small Business Administration (SBA) as well as the Centers for Medicare and Medicaid Services (CMS). While the regulatory guidance is still trickling out, these loan application windows are starting to open.  This obviously lends to a lot of confusion out there, not only for independent GI practices, but all small business owners across the country. Please find below a brief summary of some of these programs available to GI practices and suggestions on how to get started in accessing much needed financial relief. 

Paycheck Protection Program (PPP): This is a loan through the SBA which provides an immediate cash infusion into your practice based on your prior payroll history. It is focused on the preservation of your payroll and employee benefits. Much, if not all, of this funding may be also forgiven as long as you can document the use of the money for the proper items and maintain staff.

Need Help? Click here for ACG’s guidance on the PPP. ACG will update this guidance as more information becomes available. The U.S. Treasury Department also provides updated guidance.

Emergency Economic Injury Disaster Loans (EIDL): This SBA program provides small businesses with working capital loans of up to $2 million. Please note that these loans, unlike the PPP, cannot be forgiven.

Click here to learn more about the SBA’s Economic Injury Disaster Loan Program.

Economic Injury Disaster Loan Emergency Advance

This SBA loan advance will provide up to $10,000 of economic relief to businesses that are currently experiencing temporary difficulties.

CMS has provided some guidance as well as instructions on how to apply for this program. Click here to read more.


Important FDA Safety Alert: Withdrawal of Ranitidine Drugs

From ACG FDA Related Matters Committee Chair Stephen Hanauer, MD, FACG

On April 1st, the FDA announced it was requesting manufacturers withdraw all prescription and over-the-counter (OTC) ranitidine drugs from the market immediately. This is the latest step in an ongoing investigation of a contaminant known as N-Nitrosodimethylamine (NDMA) in ranitidine medications (commonly known by the brand name Zantac). The agency has determined that the impurity in some ranitidine products increases over time and when stored at higher than room temperatures and may result in consumer exposure to unacceptable levels of this impurity. ACG has previously discussed possible withdrawals of ranitidine drugs, and will continue to update membership regarding any changes to this ruling. Find the full notice from the FDA at the link below.

Highlights from ACG's 2020 "Virtual" Advocacy Day

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 77 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.

Key Messages
Today, we urged Congress to deploy all government resources necessary to make PPE available for health care providers and facilities, provide direct financial relief to independent GI practices and ambulatory surgical centers, and increase our patients’ ability to access drug infusions at a site (facility/office/home) that is best suited for them.

#PPE for #HealthCareHeroes
ACG members thanked Congress for passing the $2 trillion CARES Act, but much more needs to be done. Safety is paramount, and facilities are still struggling to maintain adequate PPE supplies.

Relief for Independent Medical Practices
While all small businesses are important, the Small Business Administration (SBA) loan applications set up in the CARES Act are first-come, first-serve and do not prioritize based on “community need.” Congress must provide immediate relief specifically for essential small businesses like GI medical practices and ASCs.

New ACG Practice Management Toolbox Article: Essential Guide to Telemedicine in Clinical Practice: EASY STEPS TO RAPID DEPLOYMENT

Drs. Eric Shah, Stephen Amann, and Jordan Karlitz outline a five-step plan for gastroenterology practices to transition rapidly and successfully to telehealth during the novel coronavirus disease (COVID-19) crisis.

The article also provides ACG members with the tools and resources to stay up to date on the latest telehealth developments occurring in your specific state.