Is 2021 actually 2020 2.0, except with vaccinations? Last newsletter we mentioned that Dr. Fauci believes that we will have herd immunity by the fall; however, we will not magically have herd immunity. In order to achieve herd immunity, we will all have to work together to make the impossible possible by doing our due diligence to get vaccinated when we are able and encourage others to get vaccinated when they are able to, wear a mask in public and practice social distancing. Achieving herd immunity will be a challenge because of various different groups – African Americans, Hispanics, Americans living in rural America and elderly Americans – that are hesitant to and face obstacles in receiving their respective COVID-19 vaccinations. Community health centers will be key in vaccinating those that are underserved and uninsured to pave the way to and reach herd immunity and are included in the Biden Administration’s plans.

Part of the success to get people vaccinated is in the medium it’s discussed and if the viewer believes that source to be trustworthy. This newsletter shares the different media platforms people are getting their COVID-19 vaccine information from – and the percentage of people that have not heard/do not believe in the vaccine myths vs the percentage of people that believe or are unsure of the vaccine myths. This newsletter, we discuss Revenue Cycle Management (RCM) and 340B Pharmacy headlined issues and how to bill the COVID-19 vaccines. The Office of Inspector General (OIG) discovered a Centers for Medicare and Medicaid (CMS) issue through an audit... and CMS doesn’t agree with OIG’s methodology for the issue’s fix. This newsletter also shares the Biden Administration’s defense of the slow roll out of the COVID-19 vaccines... and the United States’ rank against the top five countries in rank of vaccinating its population with the COVID-19 vaccines. Some states may see delays in receiving their vaccines caused by the severe weather that occurred in February. This newsletter also discusses the heartbreaking issue of child mistreatment and abuse... the people who are the first to report it and how you can ensure your team is equipped to handle such a situation.

From where the RCM process starts with credentialing a building(s)/provider(s) with several different insurance payers, the front desk’s piece of checking eligibility and choosing the correct insurance for the claim to go to, which works to manage, reduce and eliminate rejections and denials; to the handover of the claim to the back office (medical billing specialists). Medical billing specialists then create and send the claim to insurance carriers to be paid. The insurance carrier may pay the claim immediately (most ideal) or argue the claim is not to be paid (less than ideal). Though this may seem like the entire Revenue Cycle Management process, it is not; Accounts Receivable Specialists must manage and work the overall Accounts Receivable so centers can avoid massive write off’s for “timely filing.” It’s important to have secure sure processes throughout the department and mini teams that work together toward the common goal. Most centers have departments that are caught up in the day to day of the above processes that they do not have the time or the resources to get the payments paid to them or that should be paid to them. Where some centers prematurely write off revenue, it’s important to ensure you are not doing so by tracking and trending the self-pay now Medicaid later patient population (retro Medicaid payment). This is often lost as revenue because centers write off these encounter(s). This is a mistake because a self-pay patient can become a Medicaid beneficiary up to five years after their visit and Medicaid will pay the center for all of their visits within that time period.  

ACE has a team of specialists and certified professional coders (CPC) that work with you to ensure you have everything you need to increase your cash flow through its Revenue Cycle Management solutions. From credentialing buildings, providers and new services to ensure you get paid the FQHC rate all the way through the billing process, to A/R management that avoids timely filing write offs and additional programs like retro Medicaid payment that bring in additional streams of revenue. ACE ensures your patients are taken care of by their insurance carrier so you can take care of them by implementing and offering them programs and services they need that improve their overall health and quality of life.

The United States Department of Health and Human Services (HHS) has stepped into the ring on behalf of covered entities to defend them and their patients to be able to fill prescriptions at the 340B rate at contract pharmacies through its advisory opinion. While this action doesn’t carry the weight of the law, “the new advisory opinion [clarifies] that [pharmaceutical] manufacturers must provide 340B discounts when a contract pharmacy is acting as an agent of a covered entity, providing services on behalf of the covered entity.”

No matter where you are in your journey to having a 340B Pharmacy Program, we can help! We can help with implementation, management or oversight and ensure the integrity of the 340B Program and all around pharmacy compliance is achieved and maintained to help you achieve financial independence and better serve your patients.

HRSA is allowing covered entities to enroll in the 340B Program on a weekly basis! Don’t let the fear of rules and regulations keep you from better serving your patients. Pharmaceuticals and the 340B Program work to keep patients “healthy and [away from] emergency rooms and urgent care centers” through affordable health care options.

President Biden has promised to increase the number of vaccinations Americans are receiving. Between the questions posed to Moderna about getting more doses out of a single vial discussed last newsletter, COVID-19 vaccine shortages, problems scheduling and receiving the second round of the vaccines and hesitancy among those in rural America, Hispanics and the elderly without friends and family aren’t helping.

The Biden Administration said it will be months before anyone who wants to receive the COVID-19 can.

Johnson & Johnson “submitted [its] application to the FDA requesting - [and was granted] - Emergency Use Authorization (EUA) for its single dose COVID-19 vaccine.” Johnson & Johnson expects to distribute enough vaccines to vaccinate over 20 million Americans by the end of March 2021. This will hopefully assist the world in reducing the risk of COVID-19, increase herd immunity and bring an end to the global pandemic. 

KFF’s latest report shows that support systems, friends and family are key to assisting and ensuring that the nation’s elderly population receive its COVID-19 vaccinations. From transportation, being technology savvy and getting updates on when and where vaccinations are available and making appointments for the vaccination are all hurdles facing the elderly that their support systems are proving to be helpful with. How far these hurdles reach and their impact remains unknown for now.

A new report, Child Maltreatment 2019, has been released and is a compilation from the Administration on Children, Youth and Families, Administration for Children and Families (Children’s Bureau) of the Department of HHS. “Child Abuse and neglect [is defined] at a minimum [of being] any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents at imminent risk of serious harm." For 2019, 68.6 percent of reports alleging child abuse and neglect were from professionals.

Click here for the full press release and here for the executive order. 

In attempt to beat the pandemic, one of the White House's latest efforts includes sending community health centers (grantees and look-alikes) packaged pairs of "high-quality, washable masks in child and adult sizes" for each individual of the household at no cost to the community health center.

What happens if the COVID-19 vaccines are mix matched? Apparently this is a very big question that Britain scientists are exploring. Pfizer and Moderna’s vaccines require two doses of the same vaccine, days a part. The vaccines guidelines state “the vaccines aren’t interchangeable but can be mixed if the same kind isn’t available for the second dose or if it’s not known what was given for the first shot.” 

The government package for $1.9 trillion dollars passed on February 27, 2021. The package includes the following for community health centers and workforce programs:

Click here for the full press release.