CMS Confirms Medicare Loan Recoupment Delay

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.

CMS Hasn’t Started Recouping Loans by Garnishing Medicare Pay to Hospitals and Providers

As we reported on August 7, 2020, hospitals and providers are facing repayments of loans received this spring through the Medicare Accelerated and Advance Payment Programs. The first of these repayments became due in mid-August, 120 days after the first loans were issued.  These loans were set to be recouped through Medicare claim reimbursement withholding by the Centers for Medicare & Medicaid Services (CMS).  See the CMS fact sheet here.  However, although neither Congress nor CMS has taken official action to forgive the loans or issue a stay or extension on the loan collection, providers are reporting that CMS has not yet taken action to recoup the loan amounts.  This may afford Congress more time to consider taking action to extend or forgive the loans, as urged by hospital and provider advocacy groups here.

CMS Will Require Positive COVID-19 Test for Inpatient Medicare Reimbursement Add-On

On August 17, 2020, the Centers for Medicare & Medicaid Services (CMS) published new guidance stating that effective September 1, 2020, hospitals will be required to document a positive COVID-19 laboratory test to receive a 20% increase in the MS-DRG weighting factor for their inpatients being treated for COVID-19. Positive tests must be demonstrated using only the results of viral testing consistent with CDC guidelines either performed during the hospital admission or not more than 14 days prior to the hospital admission (certain limited exceptions apply).

CMS Resumes Routine Provider and Supplier Inspections

On August 17, 2020, the Centers for Medicare & Medicare Services (CMS) announced that it will resume all routine on-site surveys of Medicare and Medicaid certified providers and suppliers. Inspections had been put on hold in March to assist infection control and prioritize providers’ response to the COVID-19 emergency. CMS instructs state survey agencies to resume onsite revisits, certain complaint investigations, and annual recertification surveys as soon as they have the resources to do so.

First Provider Loans Through the Accelerated and Advance Payment Programs Come Due

As we previously reported, the Centers for Medicare & Medicaid Services (CMS) extended the Accelerated and Advance Payment Programs back in March 2020 to allow providers and suppliers to apply for advances on their Medicare payments to offset their costs and losses incurred at the outset of the COVID-19 pandemic, then curbed the programs in April. Now, repayments of the first loans are coming due. Absent a Congressional or CMS extension, 120 days after the loans were issued, CMS will recoup the loan amounts via Medicare claim withholding. Hospitals have one year from the date of the loan payment to repay the full balance of the loan, while Medicare Part A providers and Part B suppliers have 210 days. Hospital and provider advocacy groups are asking Congress to extend the recoupment period for loan recipients given the surge in COVID-19 cases and hospitalizations and the ongoing precarious financial position of hospitals and providers.

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.

Revised Medicare Billing Guidance Allows for Reimbursement for COVID-19 Counseling During Testing

On July 30, 2020, the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) revised its billing guidance to allow for payment to healthcare professionals who counsel patients, at the time of COVID-19 diagnostic testing, about the importance of self-isolating following testing and prior to the onset of symptoms. Providers should discuss with patients the signs and symptoms of COVID-19, the immediate need for isolation (including before test results are available), and the importance of informing their close contacts to separate from the tested individual. The patient should also be informed that if he or she tests positive, the patient will be contacted by the public health department for contact tracing, and that services may be available to aid the patient’s self-isolation. A counseling check list tool and links to additional information are available here.

CMS Weighs Considerations for Permanent Expansion of Telehealth Capabilities

As previously reported, Congress has been weighing legislation that would make some changes and expansions to telehealth services permanent following the conclusion of the COVID-19 public health emergency. On July 15, 2020, the director of the Centers for Medicare & Medicaid Services (CMS), Seema Verma, published a blog analyzing the data collected since the temporary expansion of telehealth and telehealth’s impact on beneficiary access to care. There has been an obvious surge in telehealth services since many restrictions and limitations were waived and patients and providers worked toward avoiding unnecessary and potentially risky in-person encounters. Looking forward to whether some of these changes may be implemented permanently, CMS is considering: (1) the importance of determining when telehealth services are clinically appropriate and safe for patients; (2) Medicare payment rates for telehealth services and whether adjustments in rates are necessary and appropriate; and (3) how CMS can protect the Medicare program from fraud and abuse by “unscrupulous actors” who attempt to manipulate telehealth services to receive overpayments.

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.