Starting January 1, 2022, consumers will have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Through new rules aimed to protect consumers, excessive out-of-pocket costs will be restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network.

Currently, if consumers have health coverage and get care from an out-of-network provider, their health plan usually won’t cover the entire out-of-network cost. This could leave them with higher costs than if they’d been seen by an in-network provider. This is especially common in an emergency situation, where consumers might not be able to choose the provider. Even if a consumer goes to an in-network hospital, they might get care from out-of-network providers at that facility.

In many cases, today the out-of-network provider can bill consumers for the difference between the charges the provider bills, and the amount paid by the consumer’s health plan. This is known as balance billing. An unexpected balance bill is called a surprise bill.

The Consolidated Appropriations Act of 2021 was enacted on December 27, 2020 and contains many provisions to help protect consumers from surprise bills starting in 2022, including the No Surprises Act under title I and Transparency under title II. Learn more about protections for consumers, understanding costs in advance to avoid surprise bills, and what happens when payment disagreements arise after receiving medical care.

https://www.cms.gov/nosurprises

If you haven’t heard about it’s impact on your department please check with your compliance or registration departments for more information.

Your NCCRA Membership Committee is writing to let you know about an opportunity to share your insight in a short survey about North Carolina Cardiopulmonary Rehabilitation Association (NCCRA) member benefits. As a Cardiac and/or Pulmonary staff member, you have earned the chance to participate in this survey being conducted by NCCRA. Your responses will be invaluable for getting staff and programs across the state more support in the future, as well as helping NCCRA improve member benefits. We want to help support you while you continue to provide quality care and services to patients throughout North Carolina. The survey is anonymous.

Your input will be most helpful if received by December 20, 2021. We are looking for feedback across all disciplines. You have hopefully received an email from your program’s director or manager.  You’ll also likely get a second email from your Regional Vice President. They have been asked to share the survey link as well to ensure we can reach as many staff members as possible.

If you don’t receive an email, please let your region’s contact person or your manager know and they can get it to you.

Mountain region: Beth Ann Scott    bascott@apprhs.org

Coastal region: Jeff Soukup    jeff.soukup@nhrmc.org

Piedmont region: Bridget Way (fill-in)   lighthouse0424@gmail.com

We know your time is valuable and we greatly appreciate your assistance.

If you are looking for your email from DHHS about your Cardiac rehab license renewal please see the latest information that we received:

“Cardiac Rehab has been delayed until the end of September.  Hopefully, if all continues to go well – we should have the online renewals ready for you at that time.”

As you may be aware the NC Medicaid Managed Care plans kicked off on July 1st.  We wanted to share some information about cardiovascular and pulmonary rehab coverage for these plans but encouraged you to contact your business office regarding your organizations participation with each plan.

In contacting United Healthcare Community Care for a patient we were told that both Cardiac (93797/93798)  and Pulmonary Rehabilitation (G0424/G0239) allow up to 15 sessions of therapy and no pre-authorization was needed.

In contacting Healthy Blue we were told that Cardiac rehabilitation must be pre-authorized and that we could suggested the number of therapy sessions we think are needed and that Clinical Review would either except or indicate the number of sessions allowed.  We were told there is no coverage for Pulmonary or Respiratory therapy.

In contacting WellCare we were told that Cardiac Rehabilitation(93797 and 93798) and Pulmonary Rehabilitation must be pre-authorized but Respiratory Therapy (G0239) did not require pre-authorization.

In contacting AmeriHealth Caritas they tell us that Cardiac Rehabilitation(93797/93798) does not require pre-authorization for participating providers but would require pre-authorization for non-participating providers. They could find no information for either Pulmonary Rehabilitation (G0424) or Respiratory Therapy (G0239) and suggested that those services would require pre-authorization.

We did not check with Carolina Complete Health or EBCI Tribal Option.

And NC Medicaid Direct is continuing with the traditional plan as it has been.

Below is are the links to the Health Plans.

https://ncmedicaidplans.gov/learn/get-answers

Health plans
For health plan questions, or to learn more about covered services, contact the health plan.

WellCare
wellcare.com/NC
This health plan is offered statewide.

UnitedHealthcare Community Plan
uhccommunityplan.com/nc
This health plan is offered statewide.

Healthy Blue
HealthyBlueNC.com
This health plan is offered statewide.

AmeriHealth Caritas
amerihealthcaritasnc.com
This health plan is offered statewide.

Carolina Complete Health
carolinacompletehealth.com
Carolina Complete Health is a provider-led entity offered to people who live in these counties: Alamance, Alexander, Anson, Bladen, Brunswick, Cabarrus, Caswell, Catawba, Chatham, Cleveland, Columbus, Cumberland, Durham, Franklin, Gaston, Granville, Harnett, Hoke, Iredell, Johnston, Lee, Lincoln, Mecklenburg, Montgomery, Moore, Nash, New Hanover, Orange, Pender, Person, Richmond, Robeson, Rowan, Sampson, Scotland, Stanly, Union, Vance, Wake, Warren, Wilson.

The Eastern Band of Cherokee Indians (EBCI) Tribal Option
EBCITribalOption.com
The EBCI Tribal Option is for federally recognized tribal members or others who qualify for services through Indian Health Service (IHS) and live in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the 5-county region. As a member of the EBCI Tribal Option, you can still get services from any Medicaid or NC Health Choice provider.

NC Medicaid Direct
bit.ly/NCBeneficiaryPortal
NC Medicaid Direct is for members who qualify.

Have you received your letter?  DHSR certification renewal will be available electronically!  Make sure you review your letter and directions so you meet the first deadline of this new process which is August 13th!

New DHSR certification renewal