ACC, Medical Community Join Together in Asking CMS For Additional Emergency Actions

The ACC joined with roughly 40 other health care organizations and specialty societies in a letter to the Centers for Medicare and Medicaid Services (CMS) urging additional emergency actions to "further enable physicians to provide necessary care to those suffering from COVID-19, as well as their broader patient populations as needed and appropriate."

Specifically, the letter urges the agency to provide payment parity, even temporarily, between telephone evaluation and management (E/M) codes (99441-99443) and office visit E/M codes to ensure that patients have maximum ability to engage with their doctors during this public health emergency. The letter also urges CMS to provide immediate guidance to Medicare Administrative Contractors (MACs) to ensure that recent CMS guidance and rules are followed appropriately to enable the payment of telephone E/M claims.

In a second joint letter to CMS sent April 10, the groups also asked the Agency to encourage Medicare Advantage and Part D plans to relax prior authorization and step therapy standards for medically necessary prescribed or ordered treatments and services during national pandemics. "Physicians are focusing on patients who require urgent or necessary care and [prior authorization] creates another hurdle to the patient trying to access this care," the letter states. "[Prior authorization] and appeals policies should not unduly burden physicians or patients or prevent them from achieving optimal outcomes."

CMS has already taken a number of actions to help clinicians more easily care for patients during the pandemic, including providing temporary enrollment flexibilities and waivers; amending coverage and quality policies; and expanding telehealth benefits.

Keywords: Medicare, Public Health, Pandemics, Centers for Medicare and Medicaid Services, U.S., Parity, COVID-19, Coronavirus, Coronavirus Infections, severe acute respiratory syndrome coronavirus 2, Telemedicine, Telephone, Office Visits, ACC Advocacy

< Back to Listings