In The News

APTA Practice Advisory

Good Faith Estimate for Uninsured or Self-Pay Patients

CMS requires providers to offer a good faith estimate of the cost of services or items to uninsured patients or those who pay cash. APTA issued this Practice Advisory on Dec. 20, 2021, to offer guidance on the requirements for providing good faith estimates on the cost of physical therapist services.

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Provider Relief Fund Payment Reports Past-Due – Consequences Already Being Enforced

Health care providers who received Provider Relief Fund payments exceeding $10,000 total between July 1 and Dec. 31, 2020, should have reported to the Health Resources and Services Administration by March 31 on how they used those funds. The following is an article by Bloomberg Law about providers that are already facing enforcement actions such as repayment or exclusion from receiving or retaining future PRF payments due to not having reported on the use of funds. 

Doctors Asked to Repay $100 Million in Covid Aid Absent Reports                                   

Bloomberg Law

The Department of Health and Human Services is clawing back as much as $100 million in pandemic assistance from health-care providers who didn’t comply with the agency’s reporting requirements.

Physician practices and clinics that received notices from HHS say they didn’t know there were strings attached to the money. Initial tranches of Covid-19 funds were deposited in some providers’ accounts without them asking for it.

Reminder emails about reporting requirements went to some facilities’ spam folders or to staffers who initially accepted the money but ended up leaving their jobs, according to the Medical Group Management Association, which represents health-care practices and providers.

The HHS’s Health Resources and Services Administration sent notices to non-compliant facilities on March 10, giving them 30 days to return the funds.

“If you do not return the funds, HRSA will initiate the recovery of all funds not reported on” during the first reporting period. Those providers will also be excluded from future payments, HRSA said, according to a sample letter obtained by Bloomberg Law. HRSA confirmed that the letters went out.

Roughly 10,000 recipients of the Provider Relief Fund are being asked to return anywhere from $30,000 to $250,000 by April 10, said Claire Ernst, MGMA’s director of government affairs. Meanwhile, they’re dealing with “everything from the highest inflation that we have seen in 40 years and potential variants down the line,” Ernst said.

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Second Booster Shots Authorized for Adults 50 and Older

CNN | By Brenda Goodman

The US Food and Drug Administration has expanded the emergency use authorization of the Pfizer and Moderna Covid-19 vaccines to allow adults 50 and older to get a second booster as early as four months after their first booster dose of any Covid-19 vaccine.

The move extends the availability of additional boosters to healthy older adults. The FDA had previously allowed additional shots for anyone 12 or older who was severely immune-deficient. This group of people can now receive a three-dose primary series and two boosters for a total of five doses.

The US Centers for Disease Control and Prevention followed suit, saying it is updating its vaccine pages to reflect the FDA's expanded eligibility.

"Current evidence suggests some waning of protection over time against serious outcomes from COVID-19 in older and immunocompromised individuals. Based on an analysis of emerging data, a second booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine could help increase protection levels for these higher-risk individuals," said Dr. Peter Marks, director of the FDA's Center for Biologics Evaluation and Research, in a news release.

"Additionally, the data show that an initial booster dose is critical in helping to protect all adults from the potentially severe outcomes of COVID-19. So, those who have not received their initial booster dose are strongly encouraged to do so."

The FDA said that in making its decision, it had determined that the known and potential benefits of second boosters outweigh the known and potential risks for these populations.

The CDC also said in its statement that adults who got Johnson & Johnson's vaccine as their primary and first booster shots at least four months prior may now get an additional booster of Pfizer/BioNTech or Moderna's vaccines.

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New Member Benefit a One-Stop-Shop for Prior Authorization, UM Advocacy Tools

APTA and the Private Practice Section have collaborated to create SPARC — the State Payer Advocacy Resource Center.

If you've crossed paths with prior authorization and other utilization management systems, you know that they're practically the definition of "administrative burden" — hours-long telephone waits that lead to dead ends, repeated jumps through hoops for incremental approvals, frustrating delays in authorizations that impede care, and more.

For the sake of the patients we serve, the physical therapy profession needs to push back, both in terms of providing needed care right now and paving the way for systemic change in the future. APTA and the Private Practice Section offer a unique collection of resources to help you do just that.

Click here to read more.


MIPS Submission Period and Exemption Window Close March 31

Get your data in by the end of the month, or consider applying for a waiver due to "extreme and uncontrollable circumstances."

March 22, 2022: Are you subject to U.S. Centers for Medicare & Medicaid Services Merit-based Incentive Reporting System requirements? There's not much time left to submit your data — or to appeal for a pandemic-related exemption.

March 31 is the deadline for MIPS-eligible clinicians who participated in the 2021 performance year of the Quality Payment Program to get their data into CMS and avoid penalties. To report, sign into the QPP webpage using your access credentials — if you haven't set up your credentials, you'll need to enroll in the HCQIS Authorization and Profile System (instructions are in this user guide). Not sure if you're a MIPS-eligible provider? Use the QPP Participation Status Tool to find out.

Click here to read more.

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