Polaris Pulse

The Polaris Pulse: CMS Issues Emergency Regulation, New Section GG Training, and More

Polaris Group Profile
Polaris Group
November 16, 2021
March 14, 2023
Polaris Group Profile
Polaris Group
March 14, 2023

Understand the latest COVID-19 regulation for healthcare workers and take advantage of new Section GG training.

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CMS Issues Emergency Regulation for Healthcare Workers for COVID-19 Vaccinations

The Centers for Medicare & Medicaid Services (CMS) is requiring eligible healthcare workers who work for a Medicare certified program to become COVID-19 vaccinated. The purpose, according to CMS, is to keep patients and healthcare workers protected and safe from catching the COVID-19 virus. CMS Administrator Chiquita Brooks LaSure stated, “Today’s action addresses the risk of unvaccinated health care staff to patient safety and provides stability and uniformity across the nation’s health care system to strengthen the health of people and the providers who care for them.”

According to CMS these requirements will apply to approximately 76,000 providers and cover over 17 million health care workers across the country. They will provide consistent standards within the Medicare and Medicaid system by providing patients more assurance of the safety of staff providing care. It is up to the facilities to establish a policy by December 5th, 2021 to ensure all eligible staff have received the vaccine prior to providing care. The eligible staff must be fully vaccinated by January 4th, 2021. These requirements will be monitored through the survey and enforcement process.  

New Updated Training Available for Section GG

CMS is offering an updated, web-based, on-demand training series on the assessment and coding of Section GG. It consists of three courses:

Course 1: Understanding Prior Functioning and Prior Device Use

Course 2: GG0130 - Self-Care Items

Course 3: GG0170 - Mobility Items

Each course includes interactive exercises to test your knowledge related to the assessment and coding of Section GG items.

The Office of Inspector General (OIG) Identifies Top Unimplemented Recommendations

The OIG has published their annual edition for the Department of Health and Human Services. Their latest edition focuses on what the OIG identifies as the top 25 unimplemented recommendations. These recommendation stem from OIG audits and evaluations prior to the COVID-19 Public Health Emergency. Two of these recommendations are specific to SNF/LTC facilities.

CMS will be reviewing the results of infection control surveys and clarifying expectations for states related to completion of standard surveys and high complaint surveys. The purpose of this recommendation is to ensure nursing facilities have an action plan in place to prevent the spread of the COVID-19 virus and keep patients safe.

CMS analyzed claims data between 2013 and 2015 to determine if SNFs correctly coded the qualifying stay using only inpatient days in the hospital and determined SNFs incorrectly used a combination of inpatient days and observation/ER days to meet the three-night requirement. The three-night requirement is a requirement for Medicare coverage to receive post-acute SNF services. CMS' analysis identified potential impacts of a 20% uptick in SNF admissions and an increase in Medicare SNF expenditures of $65 billion from 2021 to 2030.

The OIG recommendation is that CMS analyze the potential impacts of counting time spent as an outpatient toward the three-night requirement for SNF services so that beneficiaries receiving similar hospital care have similar access to these services.

MSP Clarified Policy

In the CMS MLN Medicare Secondary Payer booklet dated April 2021, there was a clarification on accepting payment for services if another insurer is primary to Medicare. Any entity providing items and services to Medicare patients must determine if Medicare is the primary payer. The clarification reads as follows:

There are no exceptions to the MSP provisions. SSA Section 1862(b)(2)(A)(i) and 42 USC 1395(y)(b)(2)(A)(i) prohibits accepting payment for services from a patient upon admission if another insurer is primary. If you’re performing this practice, you must stop immediately.

Participating Medicare providers, physicians, and other suppliers must not accept any copayment, coinsurance, or other payments from the patient when the primary payer is an employer Managed Care Organization (MCO) insurance, or any other type of primary insurance, such as an employer group health plan.

You must follow the MSP rules and bill Medicare as the secondary payer after the primary payer has made payment. In situations where you’ve taken payment from a patient, they have the right to recoup payment and you must reimburse them if necessary. (MLN006903 April 2021)

Back in September 2020 CMS issued an MLN titled “Update to the Model Admission Questions for Providers to Ask Medicare Beneficiaries”. This MLN identified CMS is modifying and streamlining the model admission questions for providers to ask Medicare beneficiaries or authorized representatives upon admission or start of care.

The revised MSP went into effect on December 7, 2020. The model questionnaire in Chapter 3, Section 20.2.1 of the Medicare Secondary Payer Manual (Pub. 100-05) lists the type of questions that providers should ask Medicare beneficiaries for every admission, outpatient encounter, or start of care with exceptions provided. All facilities should be compliant with asking these questions and documenting compliance if they are not using a form identifying these questions.

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