On November 12, 2020, the Centers for Medicare & Medicaid Services (CMS) clarified in its MLN Connects (the official CMS weekly news from its Medicare Learning Network®) that Non-Practitioners, including registered dietitians and nutrition professionals, can use the COVID-19 CPT Codes 98966-98968 to bill for audio-only telephone assessment and management services.
On November 10, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare beneficiaries can receive coverage of monoclonal antibodies to treat COVID-19 with no cost-sharing during the public health emergency. This treatment can be received in doctors’ offices, nursing homes, infusion centers, and hospitals, as long as safety conditions can be met. CMS intends to issue billing and coding instructions to providers for these treatments soon. Healthcare providers who intend to administer these treatments must be enrolled to administer COVID-19 vaccines. More information is available in the related instructions.
On October 28, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it had published a new Interim Final Rule with Comment Period (IFC) containing measures meant to remove regulatory barriers to ensure that Americans have access to affordable COVID-19 treatments and vaccines, when available. More specifically, FDA-approved COVID-19 vaccines will be covered for Medicare beneficiaries with no out-of-pocket costs. Private health plans (including non-grandfathered group health plans and health insurance carriers offering non-grandfathered group or individual health insurance coverage) must provide coverage, without cost-sharing, for qualifying coronavirus preventive services, including COVID-19 vaccines. Furthermore, the IFC includes enhanced payments for eligible inpatient cases that involve the use of certain new products authorized or approved to treat COVID-19. During the public health emergency, CMS will also pay for authorized or approved COVID-19 therapies separately from the Comprehensive Ambulatory Payment Classification to encourage the administration of these treatments in hospital outpatient settings.
On October 16, 2020, CMS announced that it will allow Medicare-enrolled immunizers, including, but not limited to, U.S. pharmacies, to bill and receive direct reimbursement from the Medicare program for vaccinating Medicare beneficiaries residing in skilled nursing facilities (SNFs). In absence of the exercise of such discretion, the Social Security Act’s Consolidated Billing Provisions would have required SNFs to bill for COVID-19 vaccine administration even when SNFs rely on an outside vendor to perform the service. CMS stated that the U.S. is facing an unprecedented challenge in meeting the urgent need to vaccinate the most vulnerable citizens in SNFs where about 30 percent of U.S. COVID-19 deaths have occurred. CMS stated, “Outside immunizers can help fill that urgent need and provide onsite vaccinations at SNFs [but] to do so during this global emergency, Medicare-enrolled vaccinators must be able to bill directly and receive direct reimbursement from the Medicare program.”
The ability of immunizers to directly bill and receive direct reimbursement will be in effect until the latter of: (1) the last day of the calendar quarter in which the last day of the emergency period occurs; or (2) so long as CMS determines that there is a public health need for mass COVID-19 vaccinations in congregate care settings.
On October 14, 2020, the Centers for Medicare and Medicaid Services (CMS) announced the release of a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version. This toolkit contains helpful examples and insights into lessons learned from various states that have implemented telehealth changes. While this toolkit is aimed at State Medicaid and CHIP agencies, it may also prove helpful to providers.
On October 14, 2020, the Centers for Medicare and Medicaid Services (CMS) announced the addition of 11 new telehealth services that Medicare Fee-For-Service will pay for during the COVID-19 public health emergency, including cardiac and pulmonary rehabilitation services. Medicare will begin immediately paying practitioners who furnish these newly added telehealth services and will continue during the public health emergency. A complete list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth is available here.
On October 8, 2020, the Centers for Medicare & Medicaid Services (CMS) announced amended terms for repayments of loans issued under the Accelerated and Advance Payment Programs during the COVID-19 pandemic. As reported last week, a new short-term spending bill, the Continuing Appropriations Act, 2021 and Other Extensions Act extended the beginning of the repayment timeframe to one year from the issuance date of the loan. This CMS Fact Sheet contains additional details and instructions on the new repayment requirements. CMS also issued Frequently Asked Questions with additional information.
As we reported last week, the Centers for Medicare & Medicaid Services (CMS) confirmed that it had delayed recouping Medicare Accelerated and Advance Payment Program loans made to providers under the CARES Act to allow more time for Congress to negotiate the repayment terms of those loans. On September 30, a short-term spending bill was signed into law that extends the date for when CMS will begin recouping those loans to one year from when the loan was issued. The bill also limits claims offsets to 25% of the full Medicare payment for the first 11 months of recoupment, followed by claims offsets of 50% for 6 months.
As we previously reported, providers who received loans this spring through the Medicare Accelerated and Advance Payment Programs were due to have Medicare claim reimbursements withheld by the Centers for Medicare & Medicaid Services (CMS) beginning in August to recoup those loans. Providers have reported that CMS had not yet taken action to recoup the loan amounts. This week, CMS Administrator, Seema Verma, confirmed in an interview with Modern Healthcare that CMS was waiting on recoupment efforts while Congress negotiated the repayment terms. The U.S. House of Representatives approved a short-term funding bill on September 22 to avoid government shutdown that contains provisions to delay the recoupment of the loans, lower the per-claim recoupment, and lower the interest rate on the loans.
As we previously reported, the Centers for Medicare & Medicaid Services (CMS) recently published new guidance requiring hospitals to document a positive COVID-19 laboratory test to receive a 20% increase in the Medicare Severity-Diagnosis Related Group (MS-DRG) weighting factor for their inpatients being treated for COVID-19. The Department of Health and Human Services Office of Inspector General (HHS OIG) has now updated its work plan providing that it will audit Medicare payments for inpatient discharges billed by hospitals for COVID-19 patients for compliance with Federal requirements, including the positive COVID-19 laboratory test requirement. Hospitals should maintain comprehensive clinical and financial documentation to support their actions and billing practices and avoid potential recoupments from audits in the future.