September 17, 2024

CMS Releases Revised Guidance for Rural Emergency Hospital Provisions, Conversion Process and Conditions of Participation

The Centers for Medicaid Services & Medicaid Services (CMS) has released guidance regarding the enrollment and conversion process for eligible facilities interested in participating in the Medicare and Medicaid programs as a Rural Emergency Hospital (REH).

Rural Emergency Hospitals (REHs) are a new provider type established by the Consolidated Appropriations Act of 2021 to address concerns over rural hospital closures. REHs provide emergency and outpatient medical and health services to patients that generally stay less than 24 hours.

As of January 1, 2023, Medicare pays REHs an additional 5% over the Hospital Outpatient Prospective Payment System (OPPS) rate to deliver emergency hospital, observation, and other outpatient services to Medicare patients. Medicare-covered REH services include all covered out-patient services, including radiology, laboratory, outpatient rehabilitation, surgical, maternal health, and behavioral health. Copayments for REH services are based on the standard OPPS rate (excluding the 5% increase).

For more information and links to the final rule, visit the CMS webpage for Rural Emergency Hospitals.

Click Here to view the Rural Emergency Hospital factsheet

September 17, 2024

Hospital OPPS Update

The Centers for Medicare and Medicaid Services (CMS) has published an OPPS update summarized in a recent MLN Matter fact sheet MM13784.

Affected providers are:

• Physicians
• Hospitals
• Home Health and Hospice
• Other providers billing Medicare Administrative Contractors (MACs) for services provided to Medicare patients

Download the fact sheet and make sure your billing staff knows about updates for:

• Proprietary Laboratory Analyses (PLA) codes
• Device pass-through
• Drugs, biologicals, and radiopharmaceuticals
• Skin substitutes
• Blood products
• Other coding changes

Click Here to Download fact sheet

September 17, 2024

Updated Fact Sheet: Collaborative Patient Care is a Provider Partnership

HIPAA, the Health Insurance portability and Accountability act (HIPAA) Privacy Rule allows you to disclose protected health information (PHI) without patient authorization to other health care providers also covered under the HIPAA rule.

• You cannot charge for providing requested documentation to another health care provider
• It is not a HIPAA violation, provided you need to provide the information for patient treatment, payment, or health care operations

Reminders:

• Be sure to document, share, and maintain all necessary documentation related to an order, referral, supply or service
• You need to provide thorough and accurate documentation to support medical necessity for services or items you provide or order
• The documentation should provide a thorough picture of what happened during the patient’s visit and tell why services or items you ordered or provided are medially necessary
• Make sure you meet all policy and coverage specific requirements

Click Here to View Updated Fact Sheet

August 28, 2024

Pharmacists as Community Health Workers Looking to Provide Telehealth Services to Rural Health Care Providers at NO COST

COUNSELMEDS is looking to partner with a rural healthcare provider to execute a Rural Citizens Access to Telehealth Grant.

COUNSELMEDS is a telehealth service where licensed pharmacists act similar to community health workers but provide additional pharmacy services to Missouri Medicaid patients with chronic and complex conditions. Their team of licensed pharmacists dedicate 1 hour of support services to each eligible Medicaid patient each month (at no cost to healthcare provider of patient).

COUNSELMEDS process includes:

1. Completing an eligibility check to identify Medicaid patients eligible for the service
2. Matching eligible patients with a pharmacist who conducts 1 hours of support services
3. At-risk patients are empowered to lead healthier lives and the healthcare provider receives additional capacity

Services include:

• Counseling on the importance of medication adherence
• Providing medication education
• Supporting patients with challenges with Medicaid coverage
• Coordinating refills
• Developing medication treatment plans
• Coordinating with staff of providers to provide exceptional care
• Coordinating free home delivery
• Monitoring and evaluating response to medication
• Assess physical and mental health status

If you are interested in partnering with COUNSELMEDS, please contact Marcus Howard at:

marcus@greaterhealthpharmacy.com or call 314 497-8553

The above program information is being shared by the Office of Rural Health and Primary Care (ORHPC) as a service of this office. ORHPC does not endorse or recommend any vendor or services. Please review for the appropriate use within your organization.