May 4, 2020

In the past week, the Small Business Administration (SBA), US Treasury, and IRS have released more rules and guidance on the PPP, and CMS issued a new interim final rule with comment period that, among other changes, increases the reimbursement for telephone-only teleheath visits.

SBA, Treasury, IRS

The federal government continues to release rules related to the implementation of the Paycheck Protection Program (PPP). On April 24, SBA released FAQs and an interim final rule clarifying that the eight-week loan period begins on the date of disbursement. Specifically, the April 24 FAQ states, “The eight-week period begins on the date the lender makes the first disbursement of the PPP loan to the borrower. The lender must make the first disbursement of the loan no later than ten calendar days from the date of loan approval.”

On April 30, the IRS issued a notice indicating that small businesses that have their PPP loan forgiven will not able to take tax deductions for their wages and other expenses for the use of that loan. The PPP loans are non-taxable income, and the IRS notice states that the PPP loan funds used to compensate employee wages will not be able to be deducted from the small businesses' annual business income. Podiatrists are encouraged to speak with their accountants about tax-related questions.

For more information about the APMA economic relief resources, including a recently-recorded webinar on PPP, visit www.apma.org/covid19sba.

CMS’ Interim Final Rule

CMS issued a new interim final rule (IFR) on April 30 that included more regulatory waivers and rule changes. These changes are meant to expand access to care and provide additional flexibility to providers in delivering that care.

Note the following changes of interest to podiatrists:

1. Payment for Audio-Only Telephone E/M Services—CMS is increasing payment for audio-only telephone E/M services (99441–99443) by cross-walking the work RVUs and direct practice expense inputs for codes 99212–99214 to the audio-only codes, on an interim basis for the duration of the COVID-19 public health emergency. 
   
   
2. RVUs Increase—CMS is raising the RVUs of CPT 99441(0.48), CPT 99442 (0.97), and CPT 99443 (1.5) to equal 99212, 99213, 99214, respectively.
   
   
3. Hospital Outpatient Departments (HOPDs)—If an HOPD has to relocate off-campus due to COVID-19 (e.g., to free up space on campus), it can continue to be paid under the OPPS fee schedule (extraordinary circumstances relocation exception). Providers can also be paid as if in the HOPD under these circumstances.

APMA will submit formal comments in response to this rule. Read the full interim rule here, and CMS' formal announcement.