Updated August 3, 2020
CMS & CDC announce provider reimbursement available for counseling patients to self-isolate at time of COVID-19 testing
Provider counseling to patients, at the time of their COVID-19 testing, will include the discussion of immediate need for isolation, even before results are available, the importance to inform their immediate household that they too should be tested for COVID-19, and the review of signs and symptoms and services available to them to aid in isolating at home. Information and resource links are available in the Counseling Check List.
The Centers for Disease Control (CDC) updated its SARS-CoV-2 page on June 13 to include an overview of testing recommendations and categories. May 29, the CDC released new Guidance for Healthcare Professionals to include information about types of spread. The agency also made updates to workplace operations during COVID-19 to include conducting daily health checks, making hazard assessments and encouraging employees to wear cloth face coverings in the workplace Also of note are interim guidelines for risk assessment and work restrictions for healthcare personnel with potential exposure to COVID-19. View the FAQ page for Healthcare Professionals to learn about the clinical features of COVID-19, risk and risk severity, infection control, reporting, and much more. You may also want to review the CDC Situation Summary Page for the latest updates.
June 8, the Centers for Medicare and Medicaid Services (CMS) has released new recommendations to health systems and patients as COVID-19 cases decline. The guidance includes reopening facilities to provide non-emergent, non-COVID-19 healthcare.
In a recent blog article by CMS Administrator Seema Verma, she outlines new flexibilities and adjustments to current and future CMMI models to address the COVID-19 emergency. This article also relays information about the CMS Innovation Center Models COVID-19 Related Adjustments Intro and Table.
June 19, CMS announced new clarification for use of the CR modifier and DR Condition Code during the COVID-19 pandemic. Please review this information carefully to ensure correct usage.
Less recent but relevant CMS Updates
May 8, CMS released a YouTube video explaining Medicare coverage and payment of virtual services. It includes answers to common questions about the expanded Medicare telehealth services benefit under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. You may also want to review another resource from CMS: General Provider Telehealth and Telemedicine Toolkit.
On May 6, CMS announced the addition of the QW modifier to HCPCS code U0002 and 87635. CMS also released a fact sheet for physicians and practitioners that summarizes many of the Cares Act, waivers for telehealth implementation during the COVID-19 crisis.
At the end of April, CMS announced new guidance on telehealth. Most notably, CMS will now pay for more than 80 additional services when furnished via telehealth. These include emergency department visits, initial nursing facility and discharge visits, and home visits, which must be provided by a clinician that is allowed to provide telehealth.
Several changes to the RHC and FQHC requirements and payments are for the duration of the COVID-19 PHE, and CMS will make additional discretionary changes as necessary to assure that RHC and FQHC patients have access to the services they need during the pandemic.up for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) during the COVID-19 Public Health Emergency (PHE) for services provided to Medicare beneficiaries. View COVID-19 Frequently Asked Questions.
CMS scaled back its Advance Payment Program, a temporary loan program that had been extended to ensure providers and suppliers had the resources needed to combat the beginning stages of the 2019 Novel Coronavirus (COVID-19). Funding will continue to be available to hospitals and other healthcare providers on the front lines of the coronavirus response primarily from the CARES Act Provider Relief Fund.
In an memorandum issued on April 19, CMS referred to "Phase I" of a three-part plan to open up America again. Some states and regions have passed the Gating Criteria (symptoms, cases, and hospitals) announced on April 16, and have been deemed ready to proceed to Phase 1.
"As states and localities begin to stabilize, it is important to restart care that is currently being postponed, such as certain procedural care (surgeries and procedures), chronic disease care, and, ultimately, preventive care." Review criteria.
Other CMS Items of note:
CMS encourages physicians that participate in the Quality Payment Program (QPP) to contribute to scientific research and evidence to fight the Coronavirus Disease 2019 (COVID-19) pandemic. Clinicians may now earn credit in the Merit-based Incentive Payment System (MIPS). View a database of privately and publicly funded clinical studies currently being conducted on corona virus.
Earlier this month, CMS expanded its current Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers. The expansion of this program is only for the duration of the public health emergency. View the fact sheet for details on eligibility and the request process.
New guidance on Modifier CS for COVID-19 was released March 18 for services furnished on March 18, 2020, and through the end of the PHE, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under these payment systems should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services.
For professional claims, physicians and practitioners who did not initially submit claims with the CS modifier must notify their Medicare Administrative Contractor (MAC) and request to resubmit applicable claims with dates of service on or after 3/18/2020 with the CS modifier to get 100% payment.
CMS issued a second Healthcare Common Procedure Coding System (HCPCS) code on March 5 for certain COVID-19 laboratory tests, in addition to three fact sheets about coverage and benefits for medical services related to COVID-19 for CMS programs.
Cybercriminals use COVID-19 pandemic to launch two new phishing campaigns
Form-based attacks are when scammers use file, content-sharing, or other productivity sites like docs.google.com or sway.office.com to dupe victims into sharing their credentials, says a May 29 article in Health IT Security Security News. Hack-for-hire groups are spoofing the World Health Organization (WHO), while other hackers are impersonating Google-branded sites.
AMA Shares Work-from-home Guidance
The American Medical Association (AMA) shared important guidance for physicians working from home. It includes a checklist for computer network safety and email cautions. View the guide.
Two new code additions intended to report when patients receive blood tests that detect COVID-19 antibodies were added to the Current Procedural Terminology (CPT®), effective April 10. These codes should be used as the industry standard for reporting of novel coronavirus antibody tests across the nation’s health care system.
On April 30, the AMA published a guide for changes to E/M coding and expediting telemedicine services. Review the guidance here.
CPT © Copyright 2019 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association. To learn more about CPT licensing click here.
Guidance for Telehealth from the FCC
The Federal Communications Commission released telehealth guidelines on April 8 for how healthcare providers can apply for money from a $200 million fund created to help them improve telehealth and mHealth programs in response to coronavirus pandemic. There are three steps that interested providers can take immediately to prepare to apply for the COVID-19 Telehealth Program. Learn more about telehealth and telemedicine guidelines from CMS: Medicare Telemedicine Healthcare Provider Fact Sheet.
PMI Addresses COVID-19 Opportunities and Risks
PMI has multiple training resources available on demand to help you navigate through the rapid changes resulting from the pandemic.
- Telehealth and COVID-19 Bundle
- Expert Panel - COVID-19 & Telehealth Q&A
- How to Get Paid for Providing Virtual Services
- Private Payers & Telehealth in the Age of COVID-19
- Practice Management Strategies During COVID-19
- Legal Concerns for Medical Practices During COVID-19
The California Medical Association has developed a substantive COVID-19 Toolkit for Physician Employers to address rapidly evolving personnel and other employment-related issues. It includes information about financial support for employees and employers, emergency paid sick leave and family medical leave policies, and other helpful guidance.
The new ICD-10-CM code for COVID-19 is valid for services April 1 through September 30, 2020. When coding U07.1, consult these guidelines released by the ICD-10 Coordination and Maintenance Committee.
The California Medical Association has published a comprehensive document relevant for industries, including healthcare providers around the country. It breaks down the Coronavirus Aid, Relief and Economic Security Act (CARES Act) approved by Congress on March 25 to support state governments, physicians, small businesses, schools, and other industries impacted by the pandemic. View document.
New Pandemic Relief for Clinicians, Providers, Hospitals & Facilities Participating in Quality Reporting Programs
CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. View the Press Release here.
The U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response developed a Healthcare Planning Checklist for everyone on the front lines of this crisis to prepare for, respond to, and be resilient in the face of COVID-19. Many of the activities in this checklist are specific for COVID-19, however many, pertain to any public health emergency.
The American Academy of Family Physicians has published an excellent checklist in PDF printable format for physician offices. The document contains tips for office preparedness, patient education, waste disposal, referral or transfer of patients and triage systems. There are additional website resources provided as well.
David T. Womack
President / CEO
This is an incredibly challenging time for everyone in healthcare. Let's support each other as we weather this storm.
We realize that some specialties may be experiencing workflow disruptions due to elective or non-emergency procedures being delayed or canceled. Consider using this unexpected idle time to put your staff through some training. Over the past two years, PMI has added dozens of new courses to its Online Training Center.
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