CMS Guidelines for COVID-19 Provider Reimbursement
May 4, 2020CMS Guideline Updates for COVID-19
The coronavirus has changed the face of healthcare in the nation, possibly forever. Currently, over 1,000,000 coronavirus cases have been identified as of the end of April, with the death toll approaching 70,000. In response to the unprecedented burden this crisis has placed on the healthcare system, the Centers for Medicare & Medicaid Services has released new CMS guidelines for the COVID-19 pandemic that affect all medical providers, including those specializing in ambulatory care. These guidelines have recently been adjusted again and are subject to more changes depending on how the pandemic develops.

CMS Accelerated Payments for COVID-19

CMS directed that accelerated and advance payments be made to providers in order to ease the financial strain that the outbreak has caused them. These payments were financed by Medicare Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B).These provisions are different than the funds provided by the CARES Act. In contrast, they serve as loans and not grants. They must be paid back at some point while the CARES funds do not. States such as New York and Texas have received the largest amounts, over six billion each as of April 24th.On April 26th, CMS updated its programs and suspended the Advanced Payment Program and are reevaluating the accelerated payment program. By that date, CMS had paid out over $100 billion to help providers battle the virus.Provider assistance will still be available through the CARES Act and the more recently passed Paycheck Protection Program and Health Care Enhancement Act, which allocated an additional $75 billion for healthcare providers. These funds will be disbursed through the Provider Relief Fund and are grants and not loans.

CMS Guidelines Remove 2% Sequestration for COVID-19

CMS has suspended the 2% sequestration for all Medicare Fee-For-Service claims put into effect in 2013. This budget-balancing measure reduced physician reimbursement for Medicare claims by 2%, benefitting the federal government but reducing revenue for providers.In another measure aimed to aid providers, CMS suspended sequestration. Claims with dates of service from May 1st to December 31st, 2020, are affected, and this action will translate to much-needed financial relief for providers.You will want to update your 2020 Medicare contracts in NextGen EPM to reflect the change in sequestration amounts.

CMS Guidelines for Telehealth for COVID-19

Healthcare providers are able to offer more telehealth services during the pandemic in order to safely offer remote care. Patients and providers looking to protect themselves and their staff can manage medical conditions without leaving home and unnecessarily exposing themselves to the coronavirus.In March, the 1135 waiver took effect, which allowed Medicare to pay for office visits to people throughout the nation, with patients being able to receive this care in their homes.Prior to this change, telehealth reimbursement was limited to a few specific circumstances. Now Medicare recipients can have their office visits, health screenings, and some other services covered.These services can be provided via the video conference or over the phone and may be combined with aid from a home healthcare worker and remote health monitoring technology.Although some conflicts have arisen between state and federal law, the waivers allow doctors not licensed in the patient's state to provide care, making it even easier to reach patients at home with an e-visit or other telehealth method.

CMS Updated Billing CPT Codes

The AMA and CMS have added CPT codes to facilitate reimbursement for COVID-19. Code 87635 became effective on March 13th, 2020, and covers coronavirus testing for diagnosis. Two new codes have recently been added:
  • 86328 - Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
  • 86769 - Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
  • 87635 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
Regular E&M codes and other CPT codes have been modified to allow prompt payment for expanded telehealth services. These changes allow for providers to receive full reimbursement for telehealth visits, rather than the previous much lower rate.

Future CMS Guideline Changes

The hope is that some of these changes will be made permanent, but their short-term presence provides significant help to providers as they fight to provide excellent patient care under extremely difficult circumstances. The testing protocol in the US is still not firmly set, although hopefully, millions will be tested for the virus in the upcoming weeks and months.CMS has made significant, although temporary, changes to its procedures to aid independent physicians and other healthcare providers during the COVID-19 outbreak. Some of those changes are ongoing, although they have suspended the Advanced Payment program on April 26th and are reevaluating its future.Congress has recently provided billions of more aid dollars to providers, and most experts feel that additional aid will be coming. That aid is dependent on the political climate in Washington DC, however. Until then, medical providers need to stay apprised of the constantly changing CMS provisions and other federal and state changes in healthcare rules, regulations, and reimbursement.

The TempDev Advantage

TempDev’s team of expert consultants stands ready to assist you in any way possible. They offer the latest in NextGen solutions, which can help you manage cases in your facility as well as accurately bill for them. At this time, your staff is in danger of being overwhelmed by the sheer number of concerned patients, many who wish to be tested for the virus. Partnering together on creating innovative solutions to fight the pandemic can help both your patients and staff by allowing them to function more efficiently and spend more time on patient treatment during this difficult time. Contact us here or by calling 888.TEMP.DEV.CMS has taken some concrete steps to address the virus and simplify testing, claim submission, quality submission, and reimbursement. Continue to look for updates from us about ways to mitigate your risk as the pandemic continues.