Telehealth G-Codes

The Health Group 

Prior to January 1, 2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on home health claims.  Effective January 1, 2023, Home Health Agencies (HHAs) may begin voluntarily reporting the new telecommunications G-codes on HH claims with HH periods of care that start on or after January 1, 2023.  On July 1, 2023, reporting these new codes will become mandatory with HH periods of care that start on or after July 1, 2023. 

Additional information is available at Telehealth Home Health Services: New G-Codes (cgsmedicare.com).

File Self-Determined CAP Report by February 28, 2023

Hospices can complete and submit their self-determined CAP Report between now and February 28, 2023. Each Medicare Administrative Contractor (MAC) has specific instructions on the completion of the report. Hospices should obtain their Provider Statistical and Reimbursement (PS&R) summary and Hospice Cap reports from the CMS Website to complete the report. Begin this process early to better plan for any potential liabilities. For more information, review the Regulatory & Compliance Center Billing & Reimbursement page.

Provider Coalition Seeks Flexibility in Proposed DOL Contract Worker Rule

McKnight’s Home Care | By Diane Eastabrook
 
A coalition of 17 provider organizations is urging the Department of Labor to consider the needs of the healthcare industry under a proposed rule aimed at cracking down on the misclassification of contract workers.
 
In a letter sent last month to DOL Secretary Marty Walsh, the groups — including the American Medical Association, the National Rural Health Association and American Association of Nurse Practitioners — argued that the rule modifying the employee or independent contractor classification under the Fair Labor Standards Act could exacerbate the worker shortage in healthcare. 
 
The organizations said the COVID-19 pandemic had increased demand for physicians, nurses and nurse practitioners, requiring providers to rely more heavily on contract workers to fill care gaps. 
 
“It is critical that the proposed rule ensure appropriate flexibility within the health care workforce so providers can continue to meet the health care needs of their communities,” the letter stated. 
 
The proposed rule will focus on whether a worker is economically dependent upon the entity sourcing the client for work or if the worker is, in fact, in business for themselves, according to home care attorney Angelo Spinola from Polsinelli Law. Spinola told McKnight’s Home Care Daily Pulse the proposed rule will negatively affect many healthcare providers, including home care agencies.
 
“It is common for providers to utilize contract labor, and the DOL’s proposed modifications will make it more likely for these contractors to be deemed as misclassified,” Spinola said. “This impacts consumer-directed models, nurse registries, home health providers who supplement the workforce with contract labor, staffing arrangements and a variety of other healthcare models. We have seen an uptick in DOL investigations surrounding contract labor and anticipate this trend will continue and create more challenges for any business utilizing contract labor if the new standard is adopted.”
 
The DOL announced the proposed rule last October, saying it would provide providers better guidance and help them avoid misclassifying employees. The department singled out home care as one of a dozen industries in which worker misclassification has been a problem.
 
“Misclassification deprives workers of their federal labor protections, including their right to be paid their full, legally earned wages,” Walsh said at the time. “The Department of Labor remains committed to addressing the issue of misclassification.

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Rate of Beneficiaries Switching From Traditional Medicare to Medicare Advantage Is Growing 

MedCity News | Marissa Plescia
 
More beneficiaries are switching to Medicare Advantage plans from traditional Medicare plans, partially leading to higher enrollment in Medicare Advantage (MA), new research shows.
 
This is a reversal from several years ago, the study published in JAMA Health Forum found. From 2015 to 2016, the switching rate from MA to traditional Medicare was 4.6%, compared to 4.1% for traditional Medicare to MA. This shifted during the 2016 to 2017 period, when the switching rate from MA to traditional Medicare was 3.7%, and 5.3% for traditional Medicare to MA. The gap became wider as years went on: in the 2019 to 2020 period, the switching rate from MA to traditional Medicare was 2%, compared to 6.8% the other way around.
 
The researchers, from KNG Health Consulting, relied on the 2014 to 2020 Master Beneficiary Summary File Limited Data Sets from the Centers for Medicare & Medicaid Services to conduct the study. They examined switching by demographic groups, Medicare-Medicaid enrollment status and mortality status.
 
MA enrollment has grown drastically in the last several years, accounting for 46% of the overall Medicare population in 2021, compared to 19% in 2007. In 2023, it is expected to cross the 50% threshold, the report stated. This increase is both because of more traditional Medicare beneficiaries switching to MA plans and new enrollees choosing MA plans, according to the report.
 
“Medicare switching behavior has changed over time, with switching into MA accounting for a larger portion of MA enrollment growth,” the researchers wrote.
 
Differences in switching rates were higher when broken out by dual-eligibility status, the researchers found. In the 2019 to 2020 period, MA to traditional Medicare was 1.6%, compared to 6.1% the other way around. For Medicare-Medicaid beneficiaries, the switching rate was 4.5% for MA to traditional Medicare and 11.2% for traditional to MA.

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