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2021 was not likely the year you expected. But it is the year you lived and learned. You focused on patients and despite changing guidelines, pivoted to stay compliant in your billing and coding. You juggled issues with new coding guidelines, claims, rejections, denials, payer-specific COVID-19 rules, and the Health Resources and Services Administration (HRSA) Uninsured program. Visit volume went up, and never decreased to pre-COVID benchmarks for many clinics. And here we are in 2022, wondering what surprises the year will bring. In this issue, we review some laws that may affect your business, explore cost-sharing for COVID-19 testing, and provide security and vaccination mandate tips. The fewer surprises, the better.

New Conversion Factor for 2022

A new law was signed by Congress on December 10, 2021 to avert an average reduction in allowables. The Protecting Medicare and American Farmers from Sequester Cuts Act addresses the reduction in the 2022 Conversion Factor set by the Physician Final Rule. The new conversion factor becomes $34.61 compared to $34.89 in 2021. With the increase in Relative Value Units on most E/M codes, the impact to 2022 rates becomes minimal.

In addition, the new law extended the moratorium on the two percent Medicare sequestration cut until March 31, 2022 and reduces the cut to one percent from April 1, 2022 through June 30, 2022.

Use this chart to compare 2022 allowables against 2021.

An image showing a table or list of 'allowables,' related to healthcare insurance coverage or reimbursement rates

The Current State of Cost-Sharing for COVID-19 Testing

Federal law requires all private insurance plans to cover the entire cost with diagnostic COVID-19 testing as long as the test is medically appropriate. Insurance plans do not have to cover screening. This is an important distinction. For clarity, the difference is defined below:

  • Diagnostic – Used for treatment. Patients are symptomatic or asymptomatic but exposed.
  • Screening – Used for administrative purposes. Patients are asymptomatic and have not been exposed.

This requirement is restricted to group health plans and health insurance issuers offering group or individual health insurance coverage. It may not include self-funded plans.

For out-of-network (OON) testing, the payment amount is the cash price for testing listed by the practice on their public website. The patient cannot be balance billed.

It’s uncertain how long payers will be required to waive cost-sharing for COVID-19 testing but will likely depend on whether the Public Health Emergency is extended. On October 18, 2021, the U.S Department of Health and Human Services renewed the declaration through January of 2022.

State laws also affect cost-sharing requirements. Be certain to check your state guidelines for changes and updates that affect your service area.

9 Security Tips to Help You Spot a Cyberattack

Viruses are stealthy and move through your system undetected. Then one day, you realize that your computer isn’t healthy and shows the symptoms of chronic problems. Just like the human body with a virus, everything you do is a chore.

If your system is stumbling instead of running, you may be the victim of a malware attack. Use this list of nine common malware symptoms that suggest your computer has been infected with a virus.

  1. Your computer is slow to react, and you have trouble loading
  2. You’re plagued by pop-ups and you can’t get rid of them
  3. You experience unpredictable computer crashes
  4. Your hard drive runs out of space or acts on its own
  5. You suddenly need new passwords, or see new browsers and links
  6. Network activity happens with no explanation
  7. Your computer just shuts down without your permission
  8. Your peers, patients, and friends get odd emails from you
  9. Your antivirus software isn’t working, and not because it needs an upgrade

If you are experiencing one or more of these activities on your computer or systemwide, contact your IT manager or your Experity team ASAP.

What You Need to Know About COVID-19 Vaccination Compliance

In November 2021, the Biden-Harris Administration issued emergency regulations requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs. But since that time, states and state coalitions have mounted legal challenges to them in federal courts across the country, leaving some urgent care centers questioning the best steps forward.

With this battle taking place in the courts, providers will not likely have clear direction on the mandates for some time. In the meantime, here are a few steps you can take to support pandemic safety and compliance.

  1. Check state and local laws first – If you’re in a state or locality with a mandate, follow that mandate and don’t wait for a decision on the federal level.
  2. If you are not under a state or local mandate, you have the opportunity to determine your own vaccination requirement in the absence of CMS rules. Do what makes sense for your practice. Be sure any vaccination requirements you impose comply with any contractual agreements you have in place with your employees.
  3. Prioritize safety – Make sure you are providing a safe environment for your staff.
  4. Be prepared to pivot – No matter what you decide, regulations could change quickly. Have a plan in place if you will need to make changes to come into compliance.
  5. Continue to stay on top of further updates – As the omicron variant continues to spread, some cities may enact local mandates that could go unchallenged.

Interested in more urgent care tips, best practices, and industry updates? Check out our November and December installments.

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