Charlotte AHEC Practice Support
February 2023 Newsletter

Payment Detail: Enhanced Medical Home Payments for Advanced Medical Homes Serving Members Eligible for Tailored Care Management

The administrative payment details and timelines for enhanced $20 per member per month (PMPM) medical home payments for beneficiaries eligible for Tailored Care Management (TCM) beginning Dec. 1, 2022, through June 30, 2023 are reviewed in this NC Medicaid bulletin.

The additional payment, paid on top of the current base PMPM fee payment of $2.50 or $5.00, to total to the $20 enhanced medical home payment level, will be made through a separate payment stream.

NC Medicaid will base the payments on the monthly enrollment used for the current Aged, Blind and Disabled (ABD) and non-ABD PMPM management fee payments to calculate the incremental PMPM payment needed.

MIPS Extreme and Uncontrollable Circumstances Extension

CMS extended the 2022 MIPS Extreme and Uncontrollable Circumstances Exception application to allow individuals, groups, virtual groups, and APM Entities to submit an application requesting MIPS performance category reweighting due to the ongoing COVID-19 PHE. 2022 MIPS EUC Exception applications citing COVID-19 as the triggering event can be submitted until 8 p.m. ET on Friday, March 3, 2023.

If you think you might quality, review the details of the EUC exception and learn about how to submit your application.

NC Medicaid End of COVID-19 PHE Toolkit

The COVID-19 federal Public Health Emergency (PHE) allowed beneficiaries to continue receiving health care coverage under special eligibility rules. The PHE rules helped prevent people with Medicaid from losing their health coverage during the pandemic.

When the federal PHE ends, Local DSS will initiate redeterminations over the next 12 months as they are due. Redeterminations that are completed the month after the PHE ends may result in termination or reduction of NC Medicaid benefits. The eligibility requirements for NC Medicaid have not changed. Per guidance from the Centers of Medicaid and Medicare (CMS), redeterminations will be initiated within 12 months and completed within the next 14 months.

To learn more and to access the toolkit, review the resources by NC Medicaid.

Medicare Part D eliminates recipients’ out-of-pocket costs for all ACIP-recommended vaccines starting January 1, 2023

The Inflation Reduction Act (IRA) eliminated out-of-pocket costs as of January 1, 2023, for Medicare Part D beneficiaries who receive vaccines recommended for adults by the Advisory Committee on Immunization Practices (ACIP). For the first time, people with Medicare’s prescription drug coverage will pay no deductible and will not be responsible for any cost-sharing for ACIP-recommended vaccines, including shingles vaccine, Tdap, and travel vaccines.

Similar benefits take effect on October 1, 2023, for adults insured by Medicaid (those eligible for both traditional and expansion Medicaid coverage) and a small number of young adults covered by the Children’s Health Insurance Program. Between now and October 1, state Medicaid programs not already in compliance will revise their Medicaid vaccine policies to implement the new law.

For key dates and more information, review the HHS announcement.

Telehealth Indicator for Doctors and Clinicians on Care Compare

The Centers for Medicare & Medicaid Services (CMS) added a new telehealth indicator on clinician profile pages on Medicare Care Compare and in the Provider Data Catalog (PDC). The new indicator helps beneficiaries and caregivers more easily find clinicians who provide telehealth services.

Telemedicine services expanded in response to the COVID-19 public health emergency to improve patients’ access to care. Last year, CMS reported a 30-fold increase in telehealth services, with more than half of Medicare beneficiaries utilizing them between March 1, 2020 and February 28, 2021. The telehealth indicator is the latest example of CMS’s efforts to ensure Care Compare provides beneficiaries and caregivers meaningful information about services they value as they search for clinicians.

For more information, access the Telehealth Indicator on Medicare Care Compare fact sheet.

Voluntary Reverification Now Open – Save Time, Save Money

Reminder: NC Medicaid has developed a unique opportunity for providers to complete the process early by voluntarily submitting a reverification application when the reverification option is displayed in the secured provider portal of NCTracks.

Read more to see if you can take advantage of this opportunity.

2023 CPT Code Update

Effective with date of service Jan. 1, 2023, the American Medical Association (AMA) has added new CPT codes, deleted others, and changed the descriptions of some existing codes. For complete information regarding all CPT codes and descriptions, refer to the 2023 edition of Current Procedural Terminology, published by the AMA. Providers should note the full descriptions as well as all associated parenthetical information published in this edition when selecting a code for billing services to the NC Medicaid.

New CPT codes that are covered by NC Medicaid are effective with date of service Jan. 1, 2023. Claims submitted with deleted codes will be denied for dates of service on or after Jan. 1, 2023. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on a deleted code that are continued with the replacement code(s).

NC Medicaid has the new and end-dated codes listed in the blog post.

Period 4 Reporting for the Provider Relief Fund

The Provider Relief Fund (PRF) Reporting Portal is now open for Reporting Period 4 (RP4). Providers who received a PRF (General or Targeted) and/or American Rescue Plan Rural payment(s), exceeding $10,000 in the aggregate, from July 1, 2021 to December 31, 2021 are required to report on their use of funds during RP4. The deadline to submit a report is March 31, 2023, at 11:59 p.m. ET.

Additional resources are also available to help while using the portal.

Regulatory Reminders – Infection Prevention and Control Toolkit

SPICE, Statewide Program for Infection Control & Epidemiology, has a multitude of resources available for practices. Providing educational opportunities for staff and providers helps to create a safer environment for patients. It is best practice to ensure there is documented education at a frequency that is in line with policy and that creates a safer environment for all. SPICE has developed a Toolkit that can meet your educational needs.

Additionally, new employees may have additional educational needs. For that, SPICE has also developed an educational module.

Make It Actionable! If you do not have a process to educate and document employee education related to infection control and prevention, review the resources to see if it meets your needs. Ensure that all employees have training documented that is in line with current policy and/or update your policy to include infection prevention and control.

Charlotte AHEC Practice Support Helping you meet the challenges!

In this time of great transition in health care practices need to position themselves for new payment models, incentive programs, and other health care reforms while refocusing on patient-centered care. Charlotte AHEC is currently able to provide these direct, individualized services at no cost.

Additional Resources:

Charlotte AHEC - Part of the NC AHEC Program
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