Government May Publish Names of Hospitals with Missing Data Reporting

On September 2, 2020, the Wall Street Journal reported that the federal government is planning to publicize the names of hospitals that have not met COVID-19 data reporting requirements as early as next week.  Hospitals are required to submit data daily to the Department of Health and Human Services (HHS) Protect reporting system on testing, capacity and utilization, and patient flows to facilitate the public health response to COVID-19.   

CMS is Reprocessing Physician Telehealth Claims That Were Denied Due to SNF CB Edits

On July 31, 2020, in a late Special Edition of the MLN News, the Centers for Medicare and Medicaid Services (CMS) indicated that claims with dates of service on or after March 1, 2020, for physician telehealth services to Medicare Part A residents in a Skilled Nursing Facility (SNF) had been erroneously denied. The denials resulted from SNF Consolidated Billing (CB) edits that otherwise disallow these claims absent the broad COVID-19 Public Health Emergency (PHE) waivers. CMS reconfirmed that physicians can use CPT codes 99441, 99442, and 99443 (on the list of telehealth codes) during the COVID-19 PHE on Medicare Part B claims for telehealth services to Part A SNF residents.  CMS stated that physicians need not take any action to have these denied claims reprocessed, further stating that Medicare Administrative Contractors (MACs) are reprocessing these claims. CMS advised physicians who had already received payment from the SNF for these telehealth services to return such payments to the SNF once the MAC reprocesses the claim.

HHS Office of Inspector General Updates its FAQs on Arrangements During the COVID-19 Public Health Emergency

On July 29, 2020, the Department of Health and Human Services Office of Inspector General (OIG) updated its FAQs published in response to inquiries from the healthcare community on the application of the OIG’s administrative enforcement authorities to arrangements connected to the COVID-19 public health emergency. More specifically, the OIG concluded that if certain conditions are met, there is a low risk of fraud and abuse for an oncology practice to offer free or discounted lodging to patients who are Federal health care program beneficiaries and who, prior to the COVID-19 emergency, would have  qualified for free or discounted housing at a nonprofit lodging facility while receiving chemotherapy or radiation treatment. Applicable conditions include: (1) the patient must reside more than fifty miles from the treatment site; (2) the patient is an established patient of the practice who scheduled the treatment prior to the offering of the free or discounted lodging; (3) the lodging aid would facilitate the patient’s access to care while receiving treatment; (4) the practice reasonably believes that the patient would have qualified for free or discounted lodging during treatment at a nonprofit lodging facility that is closed as a result of the COVID-19 emergency; (5) the aid is in-kind (as opposed to a stipend given directly to the patient); (6) the lodging is in close proximity to the treatment site; (7) the practice does not advertise the availability of this aid; and (8) the lodging is provided during the COVID-19 emergency. Healthcare providers are invited to submit inquiries to after reading these FAQs.

CMS Implements New Hospital Procedure Codes for COVID-19-Related Therapeutics

On July 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that new procedure codes are being implemented to allow Medicare to identify the use of the therapeutics remdesivir and convalescent plasma for treating hospital in-patients with COVID-19. These codes will be effective August 1, 2020 and are intended to assist tracking and research efforts of the effectiveness of these treatments. Instructions on these new codes are available here.

Reminder That Physician Orders Aren’t Required for COVID-19 Diagnostic Testing in Kentucky

On July 29, 2020, Governor Beshear reiterated that an order from a licensed clinician is not necessary for laboratory service providers to perform and bill for FDA-approved COVID-19 diagnostic tests. Additionally, pursuant to the Cabinet for Health and Family Services Department for Public Health Order, health insurers may not require a licensed clinician’s order from beneficiaries or laboratories as a precondition of covering a COVID-19 diagnostic test. Governor Beshear’s announcement was in response to reports that some individuals seeking tests are still being asked to provide a doctor’s order.

IRS Grants Extension for Non-Profit Hospital Community Health Needs Assessment Requirements

On July 14, 2020, the Internal Revenue Service extended the deadline for hospitals to conduct a community health needs assessment (CHNA). Healthcare organizations that claim non-profit status are required to complete a CHNA every three years, but the COVID-19 emergency has significantly interfered with hospitals’ ability to timely and accurately perform the assessment. The original due date of July 15, 2020 has been extended until December 31, 2020.

Hospitals Serving Vulnerable Populations to Receive Additional Aid

On July 10, 2020, the Department of Health and Human Services (HHS) announced that approximately $3 billion of Provider Relief Funds will go to hospitals serving vulnerable populations on thin margins. Many of these hospitals may have missed out on earlier fund distributions due to their low Medicare patient populations. An additional $1 billion will go to specialty rural hospitals, urban hospitals with rural Medicare designations, and hospitals in small metropolitan areas.

CMS Revises COVID-19 Medicare Fee-for-Service Billing Guidance for Outpatient Hospital Care

On July 8, 2020, the Centers for Medicare & Medicaid Services (CMS) revised its MLN Matters Article SE20011 on “Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)”.  One revision addresses services provided by the hospital in the patient’s home as a provider-based outpatient department when the patient is registered as a hospital outpatient to state as follows:

During the COVID-19 PHE, hospitals may furnish clinical staff services in the patient’s home as a provider-based outpatient department and bill and be paid for these services as Hospital Outpatient Department (HOPD) services when the patient is registered as a hospital outpatient. Hospitals should bill as if the services were furnished in the hospital, including appending the PO modifier for excepted items and services and the PN modifier for non-excepted services. The DR condition code should also be appended to these claims.

Another revision was to add a section on “Teaching Physicians and Residents” which expands the CPT Codes that may be billed with the GE modifier under 42 CFR 415.174 on and after March 1, 2020, for the duration of the public health emergency.  See MLN Matters Article SE20011 for additional information.

Hospitals Must Submit COVID-19 Patient Data via Portal for Allocation of Remdesivir Beginning July 6, 2020

As we reported in Wyatt’s weekly COVID-19 Newsletter on July 2, 2020, the U.S. Department of Health & Human Services (HHS), announced on June 29, 2020 an agreement to secure more than 500,000 treatment courses of the drug remdesivir for the United States from Gilead Sciences through September.  As Gilead’s donated supply of remdesivir has been exhausted, U.S. hospitals will be required to purchase the drug at the Wholesale Acquisition Cost (WAC) of approximately $3,200 per treatment course.  The delivery of the purchased remdesivir will be streamlined, shipping directly from AmerisourceBergen to hospitals about every two weeks.

However, a hospital’s bi-weekly purchase will be limited to the amount of remdesivir determined to be its fair share based on current COVID-19 hospitalizations reported by the hospital.  The American Hospital Association (AHA) issued a Special Bulletin last week reminding hospitals to submit their COVID-19 patient data through the U.S. Healthcare COVID-19 TeleTracking Portal each Monday by 8 pm, every two weeks, beginning today, July 6, 2020.  The AHA bulletin further states: “All hospitals should report at least the six data fields for COVID-19 admissions and ICU numbers into TeleTracking, even if they are using another reporting mechanism (e.g., National Healthcare Safety Network, or state reporting) for daily reporting.”

For additional information on how to submit data see the AHA’s Special Bulletin of May 11, 2020.

For additional information, contact Kathie McDonald-McClure, Partner, Louisville Office, Phone (502) 562-7526, Email For more information about Wyatt’s Health Care Legal Service Team and its members, click here.

HHS Announces Acquisition of Remdesivir for Purchase by US Hospitals

On June 29, 2020, HHS announced an agreement to secure more than 500,000 treatment courses of the drug remdesivir for the United States from Gilead Sciences through September, allowing American hospitals to purchase the drug at the Wholesale Acquisition Cost (WAC) of approximately $3,200 per treatment course.  Additional supplies of remdesivir have been obtained for clinical trials. HHS will allocate the remdesivir to state health departments based on the state’s COVID-19 hospital burden, and health departments will allocate it to hospitals. The delivery of the purchased remdesivir will be streamlined, shipping directly from AmerisourceBergen to hospitals, about every two weeks.  Previously, remdesivir has been donated by Gilead Sciences to HHS; however, the last of HHS’s donated supply was distributed to hospitals earlier this week.