As the COVID-19 pandemic has heavily impacted the U.S. economy, Congress has sought to intervene through the passage several legislative packages striving to minimize the overall impact to workers, businesses and the economy. Through these packages, two small business support programs were created both of which are detailed below.
The first program was created through the passage of the first COVID relief package, the Coronavirus Preparedness and Response Supplemental Appropriations Act. That bill created a $1 billion fund to immediately assist small businesses hit hard by the current economic shutdown. Unlike traditional Small Business Administration (SBA) funding mechanisms, this program is being administered directly by the SBA and is live and accepting applications currently.
The second program was created when the U.S. Senate unanimously passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020. This historic $2 trillion economic stimulus package, including $349 million in federal funds appropriated specifically to support small business, outlines two loan programs intended to assist those impacted economically by this global pandemic.
Small Business Administration Loan Program Note: Small businesses may apply to both programs but cannot participate in or accept funds from both programs. It is up to businesses to determine which program best fits the needs business before enrolling.
Access the AAOS chart that defines eligibility, what the program does, loan forgiveness, and how to participate.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act is the third Covid-19 relief-related package that was considered by Congress and signed into law by President Trump.
See the provisions most relevant to orthopaedic surgeons and their patients.
For the latest information and guidelines regarding telemedicine via telephone and video conferencing, download the AAOS Telemedicine Resource Guide
Access a comprehensive list of commercial health plan payers and their coverage policies for telemedicine services > Learn More
Find comprehensive telemedicine coding information for COVID-19: AAOS Coding Guide for COVID-19
For the latest information and guidelines regarding telemedicine via telephone and video conferencing: AAOS Telemedicine Resource Guide
AMA Special Coding Advice During COVID-19 Public Health Emergency
On March 27, 2020 the Governor announced that for a 60 day period, consumers and small businesses experiencing financial hardship due to COVID-19 may defer paying premiums for property and casualty insurance, including auto, homeowners, renters, workers comp, medical malpractice, livery and taxi. No late fees will be assessed and no negative data will be reported to credit bureaus during this time, and late payments will be payable over a one-year period. More details are forthcoming.
Additionally, you may call your malpractice carrier to ask about their additional accommodations for relief, such a reduction to part-time status.
The Centers for Medicare & Medicaid Services (CMS) announced relief for clinicians, providers, and facilities participating in the Medicare quality reporting programs.
Among other programs, clinicians and providers will be granted exceptions from reporting requirements and extensions pertaining to measure reporting and data submission for the Merit-based Incentive Payment System (MIPS). The deadline for submitting 2019 MIPS data has been extended to April 30.
Those clinicians who fail to submit their MIPS data by that date will receive an extreme and uncontrollable circumstances exemption (i.e., they will receive a neutral adjustment).
> Learn more
Both the New York State Department of Financial Services (DFS) and Department of Health (DOH) have sent out notifications relating to the Covid-19 outbreak reminding health insurers, physicians and hospitals that New York law requires coverage for telemedicine in the same manner as if care had been provided in an office setting. For more information about how to start and choosing a vendor visit the AAOS Practice Management/Telemedicine center
Summary of Medicare Telemedicine Services
We have all been receiving multiple notifications and updates on the COVID-19 pandemic. There are more confirmed cases, school systems are closed and concerns regarding infrastructure, ICU beds, emergency room and hospital personnel exposure, and recent more restrictive bans on gathering sizes and nursing home visitation. The CDC recommends rescheduling non-urgent outpatient visits as necessary.
Current efforts to mitigate the spread of the virus include social distancing and quarantine restrictions as necessary depending on exposure, risk, symptoms, and testing. Testing still lags behind and hopefully continues to improve. As physicians we need to continue to be prudent, compassionate, lead by example, and be guided by science. We collectively need to practice improved health hygiene going forward and limit the spread not only of this virus, but other innumerable transmissible diseases in our society.
Our Executive Director Babette Grey is continuing to actively monitor the MSSNY website, New York State Department of Health, CDC, and other resources daily. She and the board are a resource and are here to help as needed. > Access the resource page
Protecting our patients, staff and visitors continues to be of the utmost importance. My private single specialty orthopaedic practice, physical therapy, imaging and ASC process more than 1000 patients per day. Instituting social distancing earlier has been shown to save lives. Many of our patient population falls into a vulnerable category and much of the work we do is elective. We currently are seeing urgent patients and keeping our open access clinic for fractures open to help offload the emergency rooms with screening of patients and discouraging non--urgent office visits. That being said, we are still having patients in the elderly group trying to walk in to get a cortisone shot in the knee and other nonessential visits as today I have seen patients with arthritic knees and pain since July and an elbow problem since July despite discouraging those visits. This is one of the problems unless people completely shut down.
On behalf of the NYSSOS Board, our thoughts and prayers are with you and your families, patients, staff, facilities and your communities. We are continuing to work for the orthopaedic surgeons of the state of New York and nationally to be able to continue to improve the ability to take care of musculoskeletal problems for our patients. Please reach out to us if we can be of assistance or a resource.
James Slough, MD FAAOS
Physicians should utilize the New York State Department of Health website that has up-to-date information on COVID-19 and includes information on known cases of COVID-19, cleaning and disinfection guidance, help for childcare providers and schools, and guidelines for individuals who have recently traveled internationally.
COVID-19 is a reportable disease. If novel Coronavirus is suspected, immediately notify the local health department (LHD) where the patient resides.
Health care providers should review: CDC's Interim Guidance for Healthcare Professionals Evaluating Persons Under Investigation (PUI)
Free Communication Resources
CDC offers free resources including video, fact sheets, and posters. https://www.cdc.gov/coronavirus/2019-ncov/communication/index.html
CDC Website for Healthcare Professionals
OrthoInfo, the AAOS patient education website, is a free member resource that provides orthopaedic surgeons and patients with authoritative, in-depth information about musculoskeletal health.
The website features more than 400 articles, videos, and animations on common orthopaedic problems, surgical procedures, nonsurgical treatments, injury prevention, and healthy living. All content is developed and peer reviewed by AAOS members.
Written in simple language, OrthoInfo articles can help your patients be better informed and participate more fully in their care and recovery.
Visit the site
The Centers for Medicare & Medicaid Services (CMS) proposed a three-year extension and changes pertaining to episode definition and pricing to its Comprehensive Care for Joint Replacement (CJR) model.
The proposed changes would incorporate outpatient hip and knee replacements into the episode of care definition, as well as change the reconciliation process, the beneficiary notice requirements, gainsharing caps, and the appeals process.
The CJR model three-year extension would provide time to assess the changes in practice. > Learn More
Editor’s note: AAOS partners with KarenZupko & Associates, Inc. (KZA) on the organization’s coding education, and KZA often provides content for AAOS Now. For more information, visit www.aaos.org/membership/coding-and-reimbursement.
Whether due to the complexities of hiring billing staff or a result of hospital employment and practice acquisition, many orthopaedic practices are moving their billing operations to a third-party entity or centralized billing office.
This process is part of what institutions call revenue cycle management.
If you find yourself in this situation, these best practices will help improve coding accuracy:
NYSSOS serves the interests of New York orthopaedists and their patients by helping to create an optimal practice environment in which to provide quality and efficacious orthopaedic care.
Address: PO Box 38004, Albany, NY 12203