December 2020 Ebrief

Edition: December 2020

Table of Contents

Letter from the Editor

I am happy to share a bit of good news at the end of a tough year…

CMS released On October 30, 2020 notification of a pilot process enabling Medicare Administrative Contractors (MACs) to request pertinent documentation from an ordering provider during medical review in an effort to support the necessity and payment for radiology services billed to Medicare.

MACs have the ability to deny a claim if a benefit category, exclusion or coding issue is in question or to send an Addition Documentation Request (ADR) to the provider in order to review records to determine medical necessity and whether the claim is payable.

Previously, a request for medical records was the responsibility of the provider to obtain supporting documentation as needed from the ordering provider. The ordering provider should submit requested documentation (notes supporting medical necessity, progress notes, etc.). Ultimately it is the radiology provider selected for review whose payment is at risk. It is the radiology provider who is responsible for submitting requested documentation within required timelines requested by the MAC. There are instances when radiology service providers are unable to acquire this supporting documentation by the ordering provider.

For reference to the Medicare Program Integrity Manual Click Here

This change which takes effect Dec. 1, 2020 stipulates that MACs should begin requesting supporting documentation from ordering providers to determine whether payment is warranted. Under the pilot MACs will now conduct these reviews by reaching out directly to the ordering physician rather than the radiology provider.

The ACR Contractor Advisory Committee Network applauded the change stating, “This is a big deal and something we have been pushing for years”.

To view the official instruction, CR 11659, issued to your MAC, Click Here

We will continue to monitor and report to FRS members the impact of this pilot as it rolls out. As we approach the “socially distanced” holiday season, I am hopeful that despite the necessary changes in how we celebrate that your holidays will remain filled with health and happiness.

Laura Vallow, M.D.
Secretary, FRS
Vallow.Laura@mayo.edu

Meet Your 2020 – 2021 FRS Executive Committee

President
Douglas Hornsby, MD

President-Elect
Rajendra Kedar, MD, FACR

Treasurer
Chintan Desai, MD

FRS President’s Message

By the time the e-Brief is published, the US Senate may have decided the final 2021 Medicare Physician Fee Schedule. I would like to personally thank all the individuals who responded to our CALL TO ACTION and appealed to our senators to delay the implementation of the Medicare Physician Fee Schedule which is due to go into effect in January of 2021.

As many of you know, next year’s meeting for ACR has been changed to a Zoom-only conference for the second year. This raises a barrier to coordination and communication of our efforts on both the state and national legislative levels and our ability to affect implementation in our interests. In addition, CME credits will have to be acquired using online services. The ACR has many CME courses that can be purchased and performed online. While there are several excellent purveyors of Online CME, I would like to recognize Dr. Larry Muroff, one of our several Internationally known members, for his leadership in this arena.

In reviewing the Florida Medical Association news, there is a notice concerning fraud scheme targeting physicians. The scammers claim to represent state medical boards and federal law enforcement agencies charging MDs with criminal acts which may compromise medical license that has been suspended or demands payment under threat of legal action. I have personally received such direct calls and numerous emails, which had the same intent to defraud. Never send requested money is an obvious recommendation, but the phone call I received was intimidating. In an additional scheme, I was notified that my license in Texas had been revoked. Since I never had a license in Texas or applied for a license in Texas, this was an obvious scheme to defraud.

We are all exhausted from the continued stress of the pandemic. Many of us are exhausted to even talk about it; however, the threat is increasing over the next several months until vaccinations are available to healthcare workers and the most vulnerable portions of the population. Many of us are living in dark caves with limited outside contact, but help is on the way.

This is the last e-Brief for 2020. We will remember and be glad to be through with 2020. We wish everyone a happy and safe holiday season and look forward to the prospect of a better New Year in 2021. I hope to see you on the other side.

Doug Hornsby, MD
President, FRS
doughornsby@msn.com

Secretary
Laura Vallow, MD

Past President
Patricia Mergo, MD, FACR

Legal Counsel
Michael M. Raskin, M.D., J.D., FACR

FRBMA President’s Message

Payment Protection Plan (PPP) Loans, What’s Next?

This article will discuss three topics related to the PPP Loans. Documentation, Forgiveness, and Impact of PPP Loan forgiveness on your company’s tax return. Let me start out by saying I am not providing legal advice or accounting advice. Each situation is unique enough that you should be consulting with professionals that have experience in PPP Loans. The goal of this article is to increase your base of knowledge to assist you in your discussions that you have with the expert you decide to work with.

My source of information comes from three local accounting firms I am working with plus monthly web-based calls with two radiology Management Service Organizations (MSO). One is a state wide Florida MSO and the other is a national organization. These MSO’s have a scheduled web-based call at least once per month. In addition to getting input from the nearly 100 groups that participate in these calls, the national MSO also had a consultant with BKD CPAs and Advisors make a presentation and provide Q&A on our November call giving the members a comprehensive analysis of PPP Loans and related issues.

Documentation

If you have over a $2,000,000 PPP loan you will be audited. Regardless whether you are over that threshold or not you should be prepared for an audit. Here is what we implemented:

All proceeds from PPP Loan were deposited in a separately established bank account set up solely for the purpose of depositing and then utilizing PPP funds.
As you utilize the funds you cut checks from the PPP account to your company to reimburse your company for qualified PPP expenditures. Each check cut against the PPP account should be supported by a detailed worksheet of the items paid. This gives you the ability to easily show the auditor the use of funds.
Track employee status changes for all your employees during the PPP Loan period including: changes in number of employees, changes in hours worked, changes in pay.
Document any situations where an employee elected to terminate from your company during the PPP Loan period.
Utilize the same documentation for other COVID related funds from grants or other government funds you received and verify that the same company expenditure was not paid using multiple government funds.
Ensure that all your documentation can be easily followed and there are notes and explanations.

Forgiveness

You submit your loan forgiveness application to your lender. Go to the Small Business Administration website (SBA.gov) to find the application. You do not need to log-in or have an account. The application is fairly straight forward but you should have you accounting specialist review it for you before you send it to your lender. Your lender has up to 60 days to review your application. Once approved, your lender will send your application to the SBA. The SBA has up to 90 days to approve the loan forgiveness. The whole process can take up to 5 months. Note that no loan payments are due while your loan PPP Loan is going through the forgiveness process. I have heard from some groups that the lender sent a letter requesting loan payments to begin, if you are within the time periods discussed above then call your lender.

Impact of Loan Forgiveness on Company Tax Return

PPP Loan proceeds and the related expenses that you paid with the PPP Loan proceeds are, from a tax accounting perspective, treated as follows: 1. The PPP Loan forgiveness is not taxed as income to your corporation. Essentially the write-off of the loan proceeds is tax free to your company 2. The expenses you paid with the PPP Loan proceeds are not deductible on your corporation’s tax return if the PPP loan proceeds were used to pay those expenses.

When you consider those two points along with the long lag in determining loan forgiveness, you probably see the issue. The likely scenario is that you will use you PPP Loan funds in 2020 but your loan forgiveness will not be determined until sometime in 2021. In fact, you likely will not know the PPP Loan forgiveness outcome until after your 2020 tax return filing deadline.

The question then is how do you treat expenses you paid with the PPP loan on your tax return for 2020 if you have not heard if your PPP Loan was forgiven? Luckily the IRS has provided guidance on this question. You can find this Revenue Ruling by searching for “Revenue Ruling 2020-27”. Make sure you’re looking on the actual Revenue Ruling which will be on irs.gov. The Revenue Ruling offered guidance stating: If a company has a reasonable expectation of loan forgiveness then the deduction for expenditures by the company that were paid via the PPP Loan proceeds, are not deductible in the year the PPP Loan proceeds were used (i.e., PPP Loan used to pay quailed business expenses in 2020, then those expenditures are not deductible in 2020). What is reasonable expectation? The ruling states, if you filed your loan forgiveness application and you followed the PPP Loan utilization requirements then you have a reasonable expectation of forgiveness. The same would be true if you took all the steps above but had not yet filed the application. Therefore, in most scenarios you will be disallowed the deduction in your 2020 tax return for 2020 company expenses paid with the PPP loan. If you have a different scenario then discuss that scenario with your accounting specialist.

The impact of applying this Revenue Ruling is just the timing of the benefit of the PPP Loan Forgiveness. Under this Revenue Ruling, the benefit of the PPP Loan will impact 2020 income (when you used the PPP Loan funds) vs 2021 (when the Loan was forgiven).

I am impressed at how well this program was implemented. The forgiveness process also appears to be relatively simple. The tax issues, although somewhat complex, was directly addressed in a recent Revenue Ruling. Truly a business saving program that made a difference.

John Detelich, CPA, MBA, CEO
President, FRBMA
jdetelich@radassociates.com

Legislative Update

Florida’s Organizational Session has come and gone. The members were here Tuesday November 17th to be sworn in. Nine members were unable to attend due to having Covid or having been exposed to Covid. Two Senators and seven House members. My husband and I did not attend as we both were exposed to Covid on October 30th, both tested negative (rapid test) 5 days after exposure. That afternoon, two hours after negative results, my husband started having fever and aches. I thought he had the flu and treated him for that. He retested for Covid and flu two days later and tested positive for Covid. Fortunately, he had a light case and I did not catch it. He is completely recovered. To All, please be careful!

The Senate picked up a new Republican seat during this campaign cycle; so, Wilton Simpson was easily officially voted in as President of the Senate. Senator Aaron Bean was designated the President pro tempore and it was announced Senator Kelli Stargel will be Appropriations Chair. Senator Debbie Mayfield was made Majority leader.

In the House, the Republicans picked up five new seats; so, Chris Sprowls was also easily officially designated Speaker of the Florida House.

Speaker Sprowls announced Rep Bryan Avila as Speaker Pro Tempore, Rep Jay Trumbull as Appropriations chairman, and Representative Mike Grant as Majority Leader.

There are no legislative meetings until January 11-14th and then again the week of January 25th. There still has been no announcement made on how the public will be allowed into the Capitol in January. Hopefully a vaccine will be released and the world will settle back down a bit.

There has been continued discussion on liability protection for business and medical groups from suits due to Covid.

Hopefully something positive will be able to pass this upcoming session.

Please everyone stay safe this holiday season!

Thanks,
Alison Dudley, FRS Lobbyist
AlisonDudley@dudleyandassociates.com

SUBMIT AN ARTICLE

FRS Educational Foundation

Qualified Charitable Contributions

As fall approaches, keep in mind the FRS foundation still values and relies on your charitable support of Florida’s Radiology and Radiation Oncology residents as part of our ongoing educational mission. As many of you may be aware, the CARES Act was passed by Congress in response to the pandemic and waives the required minimum distributions (RMDs) for all types of retirement plans for 2020.

Many of our members have previously used Qualified Charitable Distributions (QCD) as a means to donate to the FRS Foundation and this remains an option for 2020 despite the waiver for RMD and still holds tax advantages even if one takes a standard deduction. The QCD allows IRA owners over age 70 ½ to directly transfer up to $100,000 annually from an IRA to a qualified charity tax free, is excluded from income and allows you to get a tax break even if you are claiming the standard deduction. Individual circumstances may obviously vary and we advise you check with your accountant to explore individual benefits of using a QCD for your charitable contribution.

We hope that you will consider the benefits of a QCD and help the FRS Foundation continue to grow and prosper through your generous contributions.

Jeffrey Stone, M.D., FACR
President, FRS Educational Foundation

Job Board
	Available Positions Spectrum Healthcare Resource

Job Posting Opportunities

Florida Radiological Society is pleased to introduce the opportunity for interested parties to advertise for potential jobs in our monthly FRS Ebrief bulletin.

Advertisement pricing is as follows:

Ebrief Job Posting pricing:
3 months ($100 monthly)
6 months ($90 monthly)
12 months ($80 monthly)

Please contact Lorraine Roger, our Society Administrator for further information on how to advertise in our monthly publication.

ph (813) 806-1070
fx (813) 806-1071
email lroger@flrad.org

We feel that this will provide a valuable service to both our members and our Florida community of Radiology.

Thank you for your interest!
Patricia Mergo, MD, FACR

Become a PAC Member Today

Attention FRBMA Members! Please support the cause. We encourage you to be PAC members and supporters; you do not have to belong to the FRS. Donations can be made online through our PAC website www.FLRADPAC.org. Thank you for your donation.

It is critical that we support both our Florida PAC and RADPAC in order to bolster our voice in Tallahassee and Washington, respectively. Please join FRS lobbyist Alison Dudley in her special appeal for all Florida radiologists to become Florida PAC members. If you would like to help FRS defend radiology against untoward legislation and introduce bills that have a positive impact on our practices, we need your financial support to re-elect our friends in the state House and Senate. The FRS can also show you simplified ways on how to sign up your radiology group. Contact Lorraine Roger at lroger@flrad.org or contact Alison Dudley at alisondudley@dudleyandassociates.com for more information.

Telephone (813) 806-1070 • Fax (813) 806-1071
5620 W. Sligh Avenue • Tampa, Florida 33634

The E-Brief is an exclusive member benefit of Florida Radiological Society, delivering monthly member, chapter and industry news. Please do not reply to this automatic e-mail. For comments or questions about the E-Brief, please contact lroger@flrad.org.

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