Costs for testing are being waived as diagnostic tests proceed.
EDITOR’S NOTE: The World Health Organization (WHO) has declared that the coronavirus is now a pandemic.
With the novel coronavirus (COVID-19) outbreak intensifying across the country and large-scale public gatherings of all types being postponed or canceled en masse, federal officials and insurers are scrambling to eliminate financial barriers to testing and care, marking part of a broader effort to ensure that the nation’s healthcare infrastructure does not become overwhelmed.
The Centers for Medicare & Medicaid Services (CMS) announced Tuesday that many leading insurance companies and their industry associations are now indicating that they will be treating COVID-19 diagnostic tests as covered benefits, and will be waiving cost-sharing that would otherwise. The agency also pledged to provide more flexibility to Medicare Advantage and Part D plans, “to ensure they have the tools they need to provide seniors with the best coverage.”
As part of a flurry of related activity, CMS published a memorandum to Medicare Advantage (MA) and Part D health and prescription drug plans, informing them of the flexibilities they have to provide healthcare coverage to Medicare beneficiaries for COVID-19 testing, treatments, and prevention.
More than 1,000 people have now tested positive for the virus in more than 30 states, with pockets of infection reflecting substantial ease of spread.
“The President directed CMS to make sure Medicare Advantage beneficiaries have access to the healthcare services they need during this time,” CMS Administrator Seema Verma said in a statement. “Today we announced guidance to Medicare Advantage and Part D plans to remove barriers that could prevent or delay beneficiaries from receiving care. Medicare beneficiaries are at the greatest risk of serious illness due to COVID-19, and CMS will continue doing everything in our power to protect them.”
In the aforementioned memorandum, CMS outlined the flexibilities MA and Part D plans have to waive certain requirements to help prevent the spread of the virus; specifically, the relief involves:
The changes mark part of a broader effort on the part of the newly created White House Coronavirus Task Force, which has publicly announced an intention to ensure that all Americans – particularly those at high risk of complications from the COVID-19 virus – have access to benefits while helping to contain the spread of disease.
To view CMS’s memorandum for MA and Part D plans, go online to https://www.cms.gov/files/document/hpms-memo-covid-information-plans.pdf.
CMS has announced changes in policy to address the coronavirus outbreak several times per week recently, including half a dozen times since the start of the month alone:
On March 9, CMS delivered guidance on the screening, treatment, and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of COVID-19 in a hospice setting. CMS also issued additional guidance specific to nursing homes to help control and prevent the spread of the virus: https://www.cms.gov/newsroom/press-releases/cms-issues-clear-actionable-guidance-providers-about-covid-19-virus
Also on March 9, CMS issued a press release highlighting the telehealth benefits in the agency’s Medicare program for use by patients and providers: https://www.cms.gov/newsroom/press-releases/telehealth-benefits-medicare-are-lifeline-patients-during-coronavirus-outbreak
Additionally, on March 9, CMS published guidance to hospitals with emergency departments (EDs) on patient screening, treatment, and transfer requirements to prevent the spread of infectious disease and illness, including COVID-19, ordering that Medicare-participating hospitals follow both Centers for Disease Control and Prevention (CDC) guidance for infection control and Emergency Medical Treatment and Labor Act (EMTALA) requirements: https://www.cms.gov/newsroom/press-releases/cms-issues-call-action-hospital-emergency-departments-screen-patients-coronavirus
On March 6, CMS issued frequently asked questions and answers (FAQs) for healthcare providers regarding Medicare payment for laboratory test and other services related to the outbreak: https://www.cms.gov/newsroom/press-releases/covid-19-response-news-alert-cms-issues-frequently-asked-questions-assist-medicare-providers
On March 5, CMS issued a second Healthcare Common Procedure Coding System (HCPCS) code 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: https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests
On March 4, CMS issued a call to action to healthcare providers nationwide and offered important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare: https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus
Well, I gave you all a break from my criticism of insurance company policies and ploys last week, and I had planned to go for
The Centers for Medicare & Medicaid Services (CMS) issued the review copy of the Fee Schedule, Friday, Nov. 1. Usually, the final copy appears about
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
