Navigating Post-PHE Changes: Impact on Healthcare Providers and Compliance

Blog Contents

As the Public Health Emergency (PHE) draws to a close on May 11th, 2023, healthcare providers must adapt to the new regulatory changes, update their workflows, and ensure proper training for physicians and staff. In this blog post, we will review the key considerations for healthcare providers as they navigate critical post-PHE changes.

What was the Public Health Emergency (PHE), and What did it do?

The Public Health Emergency (PHE) was a federal declaration made by the Secretary of the U.S. Department of Health and Human Services that was put in place in response to the COVID-19 pandemic.

How can ending the Public Health Emergency (PHE) impact my organization?

The PHE emergency declarations had significant impacts on the Centers for Medicare & Medicaid Services (CMS), which allowed for changes to many aspects of healthcare delivery during the COVID-19 PHE. Some of the changes will be permanent. However, many of the waivers are expiring as they were only put in place as a measure to respond to the pandemic. Healthcare providers previously received maximum flexibility to streamline delivery and allow access to care during the PHE.

Here are five of the expiring changes we think you should know:

National Medicaid Coverage:

With the end of the PHE fast approaching, there are reports of up to five million patients that may lose their Medicaid coverage as eligibility redetermination resumes on April 1st, 2023.

PHE Reimbursement Changes:

Hospitals that treated COVID-19 patients during the PHE received a 20% reimbursement increase. After the PHE, this additional payment will no longer be available.

Supervision Rules:

The 1135 Waivers allowed non-physician providers to expand their roles during the PHE. Once the PHE ends, the Centers for Medicare & Medicaid Services (CMS) will reinstate the original supervision and mandated physician service rules.

Liability Immunity & State Licensure:

The PREP Act granted liability immunity to certain healthcare providers during the PHE. After the PHE, providers crossing state lines to practice medicine must be licensed in that state or risk practicing without a license. After the PHE, providers with expired licenses will need to renew them to continue practicing without risking penalties.

Telehealth Services:

Modifiers: After the PHE, healthcare providers must use the modifier “95” and the appropriate place of service (POS) indicator when billing for telehealth services. Beginning January 1, 2023, providers must also use CPT modifier “93” for eligible mental health services provided using audio-only technology.
Audio-Only Services: After the PHE, certain audio-only services will still be covered through 2024, but only for established patients and when deemed “appropriate.” All required elements of the phone call codes (99441-99443) must be met.
Removed CPT Telehealth Service Codes: Centers for Medicare & Medicaid Services (CMS) removed four CPT telehealth service codes (96121, 99221, 99222, 99223) from the approved list. Be aware of these changes and adjust billing practices accordingly.

How can we prepare our practice and providers for the end of the PHE?

As an organization, it is critical to review all available PHE guidance from sources like Centers for Medicare & Medicaid Services (CMS) and your local Health and Human Service Administration (HHS). The ending of the PHE will affect each practice differently, and it’s imperative to do your due diligence on behalf of your organization. It’s better to be over-prepared and compliant than underprepared and out of compliance.

As a provider, reviewing all available PHE guidance from your licensing board is critical to avoid falling out of compliance and impacting your ability to provide services to patients. Providers should be up to date on PHE changes to licensure as providers crossing state lines to practice medicine must be licensed in that state or risk practicing without a license. Providers will have to apply for full licenses through the respective state Boards. States who previously allowed providers to apply for temporary 90-day licenses have ended those waivers.

Here are some additional actions you can take to ensure your organization and its providers are prepared for the end of the PHE.

It is imperative to ensure your scheduling or eligibility department verifies Medicaid patient coverage and updates their charts to avoid potential denials.
Review your organization’s current contracted rates and seek updated fee schedules for the 2023 year for your contracts.
Work with your organization’s administrative staff to review supervisor requirements and regulations. Provider supervision requirements are available through their licensing boards and your state’s rules and regulations.
Ensure your providers are aware of their licensing due dates and renewal deadlines. Have any provider with upcoming licensure renewal ensure they renew ahead of time. For multistate licensure, ensure your provider follows all multi-state licensure guidelines, if they are required to obtain licensure in a state post PHE, move forward with having your provider apply.
Review your organization’s telehealth servicing, billing and coding policies to ensure they update office procedures and claims as necessary per the PHE telehealth changes. This includes scheduling telehealth appointments per the allowed systems, documenting Telehealth visits accordingly, and using the correct modifiers when necessary.
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PayrHealth: Navigate PHE Changes with Expert Support

If you’re looking to start or grow your medical practice and need support in navigating these critical changes, contact PayrHealth for expert guidance. Additional resources available at https://payrhealth.com/ Questions? Contact us at 512-812-8658.

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