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CMS Interim Final Rule – Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (PHE)

Craneware® Insights Regulatory Updates – CWI1223 (14 April 2020)


Topic

CMS Interim Final Rule – Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (PHE)

On April 6, 2020, Medicare issued the Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency interim final rule (42 CFR Parts 400, 405, 409, 410, 412, 414, 415, 417, 418, 421, 422, 423, 425, 440, 482 and 510). This interim final rule contains information on changes Medicare has made to existing regulations to provide flexibilities for Medicare beneficiaries and providers to respond effectively to the 2019 Novel Coronavirus (COVID-19) public health emergency (PHE).

Provider Types Affected

Critical Access Hospitals
Comprehensive Outpatient Rehabilitation Facility
OPPS Hospitals
Provider-Based FQHC
Provider-Based Rural Health Clinics
Physicians
Skilled Nursing Facility PPS

Departments/Areas Affected

Business Office
Compliance / Revenue Integrity
Finance
HIM/Medical Records
OP Clinics
Telemedicine

What You Need to Know

On April 6, 2020, the “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” interim final rule was published in the Federal Register. CMS is waiving the 30-day delay in the effective date of the rule from the date of its publication in the Federal Register and is making this IFC effective retroactive to March 1, 2020, as permitted under 1872(e)(1)(A)(ii) of the Act (85 FR 19281). CMS is providing a 60-day public comment period for this IFC for which comments must be received by CMS no later than 5 p.m. on June 1, 2020. Please refer to the first page of the Federal Register publication (85 FR 19230) for methods and addresses for comment submission.

The information contained in the interim final rule pertains to many types of providers and suppliers. This Craneware Insights article provides a summary of information applicable to the types of providers/supplies for whom we normally provide regulatory updates. A list of topics contained in the IFC, for which we did not provide a summarization, is included at the end of this article.

Background

On March 13, 2020, President Trump declared the COVID-19 outbreak a national emergency. The changes to the Medicare regulations offer providers flexibilities in furnishing services to detect and treat COVID-19 for Medicare beneficiaries. These changes are intended to increase access to services using telecommunications technology, increase access to testing in a patient’s home, and improve infection control for Medicare beneficiaries to receive medically necessary services without jeopardizing their health or the health of those providing services (85 FR 19231-19232).

Provisions of the COVID-19 Interim Final Rule

Telehealth

The payment amounts and circumstances under which Medicare makes payment for a certain set of services furnished through interactive, real-time telecommunication technology is specified under Section 1834(m) of the Act. Many of the telehealth services are reported using the CPT/HCPCS codes that describe “face-to-face” services. The list of eligible telehealth services can be accessed on the CMS website at https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/index.html (85 FR 19232).

The Medicare telehealth benefit pays for professional services that are furnished using telecommunications technology, which include (but are not limited to) physician interpretation of diagnostic tests, care management services and virtual check-ins. Medicare pays for remote services in the same way as if the services were furnished without the use of telecommunications technology.

CMS expanded telehealth services on a temporary basis pursuant to the waiver authority added under section 1135(b)(8) of the Act by the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Pub. L. 116-123, March 6, 2020). As of March 6, 2020, Medicare will pay for telehealth services to include office, hospital, and other visits furnished by physicians and other practitioners to patients located anywhere in the country, including in a patient’s place of residence. The expansion added many services, eliminated the frequency limitation and other requirements associated with telehealth services, and clarified payment rules (85 FR 19232).

Telehealth Site of Service Differential

There are two payment rates for many physician services:

  • Facility rate: Amount paid to a professional when a service is furnished in a setting, such as a hospital, for which Medicare pays a “facility fee” in addition to the professional fee. Under telehealth, the facility fee is generally paid to the “originating site” where the beneficiary is located at the time a telehealth service is furnished.
  • Non-facility rate: Single amount paid to a physician or other practitioner for services furnished in their office.

Medicare telehealth currently makes payment to the billing physician or practitioner at the PFS facility rate since the current telehealth benefit requires the Medicare beneficiary to receive telehealth services at a permissible originating site (ie. medical facility).

Place of Service Code

Physician or practitioner claims for “traditional” telehealth services include a place of service (POS) code of “02” (Telehealth), which is paid at the facility rate. Under the waiver authority issued in response to the COVID-19 PHE, Medicare telehealth services can be furnished to patients wherever they are located, including in the patient’s home. CMS believes that the resource costs involved for furnishing telehealth services would not be significantly different than the costs involved when furnishing services in person, such as from the office location. To that end, Medicare is instructing physicians to report the POS codes on telehealth claims that would have been reported had the service been furnished in person to allow Medicare to make payment at the non-facility rate, when appropriate. CMS is also instructing physicians and practitioners to apply modifier “95” (telehealth) to claim line items that describe services furnished via telehealth (85 FR 19233).

Types of Telehealth Services

Ordinarily, evaluation and management (E/M) codes describe the level of care for different settings, such as office or emergency department. For the duration of the PHE for the COVID-19 pandemic, CMS is instructing practitioners to report the E/M code that best describes the nature of the care they are providing. CMS is also adding, on an interim basis, the following services to the Medicare telehealth list for dates of service beginning March 1, 2020 (85 FR 19235-19241):

  • Emergency department visits: CPT® codes 99281- 99285;
  • Initial and Subsequent Observation and Observation Discharge Day Management: CPT® codes 99217 – 99220, 99224 – 99226, 99234 – 99236;
  • Initial hospital care and hospital discharge day management: CPT® codes 99221 – 99223, 99238 – 99239;
  • Initial nursing facility visits and nursing facility discharge day management: CPT® codes 99304 – 99306, 99315 – 99316;
  • Critical Care Services: CPT® codes 99291 – 99292;
  • Domiciliary, Rest Home, or Custodial Care services: CPT® codes 99327 – 99328, 99334 – 99337;
  • Home Visits: CPT® codes 99341 – 99345, 99347 – 99350;
  • Inpatient Neonatal and Pediatric Critical Care: CPT® codes 99468 – 99469, 99471 – 99473, 99475 – 99476;
  • Initial and Continuing Intensive Care Services: CPT® codes 99477 – 99480;
  • Care Planning for Patients with Cognitive Impairment: CPT® code 99483;
  • Group Psychotherapy: CPT® code 90853;
  • End-Stage Renal Disease (ESRD) Services: CPT® codes 90952 – 90953, 90959, 90962;
  • Psychological and Neuropsychological Testing: CPT® codes 96130 – 96133, 96136 – 96139;
  • Therapy Services: CPT® codes 97161 – 97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760 – 97761, 92521 – 92524, 92507; *Please note: Medicare does not provide payment for these services as Medicare telehealth services when furnished by physical therapists, occupational therapists, or speech-language pathologists as they do not meet the definition of an eligible distant site practitioner (85 FR 19239); and
  • Radiation Treatment Management Services: CPT® code 77427.

Frequency Limitations on Subsequent Care Services

Certain CPT® codes that were previously added to the Medicare telehealth list have certain restrictions on how frequently a service may be furnished via telehealth. For the duration of the COVID-19 PHE, CMS is removing the frequency restrictions for the following subsequent inpatient and nursing facility visits as well as the critical care consultations (85 FR 19241-19242):

  • Subsequent Inpatient Visits: CPT® codes 99231 – 99233;
  • Subsequent Nursing Facility Visits: CPT® codes 99307 – 99310; and
  • Critical Care Consultation Services: HCPCS codes G0508 – G0509.

“Hands-on” Visits for ESRD Monthly Capitation Payments

Currently, there are certain requirements for ESRD services to be furnished face-to-face, without the use of interactive telecommunications systems (”hands on”). For the duration of the COVID-19 PHE, CMS is allowing the required face-to-face clinical examinations to be furnished via telehealth services. Additionally, CMS will not conduct reviews to determine whether certain ESRD visits were conducted face-to-face. The policy changes are applicable to the following CPT® codes for ESRD services (85 FR 19242-19243):

  • CPT® codes 90951 – 90955, 90957 – 90970

Telehealth Technology Requirements

CMS regulations at §410.78(a)(3) state that telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications systems for purposes of Medicare telehealth services. For the duration of the COVID-19 PHE, CMS is revising this regulation to define “interactive telecommunications systems” to mean “multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.” CMS is also waiving penalties for HIPAA violations against health care providers that serve patients through everyday communication technologies, such as Face Time or Skype (85 FR 19243).

Beneficiary Cost-Sharing

For the duration of the COVID-19 PHE, physicians and other practitioners will not be subject to administrative sanctions for reducing or waiving Medicare beneficiary cost-sharing obligations for services provided remotely through information or communication technology. This change in policy applies to a physician or other practitioner billing for telehealth services provided remotely or to a hospital or other eligible individual or entity billing on behalf of the physician or practitioner when the physician or other practitioner has reassigned his or her right to receive payments to such individual or entity (85 FR 19243).

Communication Technology-Based Services (CTBS)

Currently, Medicare pays for many kinds of services that are furnished via telecommunication technology but are not considered Medicare telehealth services. Medicare provided examples to include remote patient monitoring and interpretations of diagnostic tests when furnished remotely.

In the CY 2019 Physician Fee Schedule final rule (83 FR 59487), CMS finalized HCPCS code G2010 (Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment) and HCPCS code G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion). Prior to the PHE, these codes were reportable by a physician or practitioner who can furnish E/M services and limited to established patients. Beneficiary consent must be documented in the patient’s medical record for each service.

To facilitate billing of the CTBS services by therapists, CMS is designating HCPCS codes G2010, and G2012 as CTBS ‘‘sometimes therapy’’ services that would require the private practice occupational therapist, physical therapist, and speech-language pathologist to include the corresponding GO, GP, or GN therapy modifier on claims for these services. CTBS therapy services include those furnished to a new or established patients that the occupational therapist, physical therapist, and speech-language pathologist practitioner is currently treating under a plan of care (85 FR 19245). CMS is also making clear that the consent to receive these services can be documented by auxiliary staff under general supervision and that it may be obtained at the same time the service is furnished (85 FR 19244).

In the CY 2020 CMS Physician Fee Schedule final rule (84 FR 62796), CMS finalized separate payment for CPT® codes 99421 – 99423 (Online digital evaluations and management service, for an established patient…) and HCPCS code G2061 – G2063 (Qualified nonphysician healthcare professional on line assessment and management, for an established patient…). During the PHE, CMS will not conduct reviews to consider whether these services were furnished only to established patients (85 FR 19244). CMS is clarifying that several types of practitioners can bill for these services, such as licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, or speech language pathologists. CMS states that this is not an exhaustive list and they are seeking input on other kinds of practitioners who might be furnishing these kinds of services (85 FR 19245).As with HCPCS codes G2010 and G2012, CMS is designating HCPCS codes G2061, G2062, and G2063 as CTBS “sometimes therapy”, which incorporate the above-mentioned guidelines (85 FR 19245).

Direct Supervision of Interactive Telecommunications Technology

Currently, many services are paid under PFS when they are provided under a level of physician or nonphysician practitioner (NPP) supervision. Often, the supervision requirements necessitate the presence of the physician or NPP in the same location as the beneficiary who is receiving the service. During the duration of the COVID-19 PHE, CMS is revising the definition of direct supervision to allow for direct supervision to be provided using real-time interactive audio and video technology (85 FR 19245).

This also includes instances where the physician enters into a contractual arrangement for auxiliary personnel to leverage additional staff and technology necessary to provide care that would ordinarily be provided incident to a physician’s service. In this scenario, the provider/supplier would seek payment for services provided from the billing practitioner and would not submit claims to Medicare for such services. An example provided by CMS would be a physician providing a telehealth E/M visit that would need to be personally provided by the physician. The physician may want to use auxiliary personnel to be present in the home with the patient during the telehealth service.

CMS states that they would not expect services furnished at a patient’s home incident to a physician service to occur during the same period as a home health episode of care, and they will be monitoring claims to ensure services are not being inappropriately unbundled from payments under the home health PPS (85 FR 19246).

Supervision Changes for Certain Hospital and CAH Diagnosis and Therapeutic Services

For hospital therapeutic and diagnostic services that require a direct level of supervision, CMS is amending the definition to conform with the applicable definitions for services paid under the PFS, which allows the physician to provide direct supervision using real-time interactive audio and video technology, for the duration of the COVID-19 PHE. CMS is also applying this change to pulmonary, cardiac, and intensive cardiac rehabilitation for the duration of the COVID-19 PHE (85 FR 19246).

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

Currently, the payment rates for RHCs and FQHCs reflect the cost of all services and supplies furnished to a patient in a single day. They are also paid for care management services, which are typically non-face-to-face services.

In the CY 2019 PFS final rule (83 FR 59683), CMS finalized a separate payment “Virtual Communication Services”. CMS established HCPCS code G0071 (Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an RHC or FQHC practitioner and RHC or FQHC patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an RHC or FQHC practitioner, occurring in lieu of an office visit; RHC or FQHC only).

HCPCS code G0071 requires that services furnished by an RHC or FQHC practitioner are provided to a patient who has had an RHC or FQHC billable visit within the previous year. For the duration of the COVID-19 PHE, CMS is waiving this requirement and allowing this service to be furnished to new patients, as well (85 FR 19230).

On an interim basis, CMS is expanding the services that can be included in the payment for HCPCS code G0071 and updating the payment rate to reflect the addition of the following services:

  • 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes);
  • 99422 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11– 20 minutes); and
  • 99423 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes).

Clinical Laboratory Fee Schedule for Specimen Collection

In response to the COVID-19 PHE, CMS is changing the payment policy to provide payment to independent laboratories for specimen collection for COVID-19 testing. Currently, section 1833(h)(3) of the Act provides payment for specimen collection, transportation and personnel expenses for trained personnel to collect specimens for home bound patients and inpatients (not in a hospital), in addition to the payment provided under the Medicare Clinical Laboratory Fee Schedule (CLFS).

CMS states that the nasopharyngeal (NP) or oropharyngeal (OP) swabs or collection of sputum will require a trained laboratory professional and will also require additional precautions to minimize exposure, which will result in higher costs. To reflect the higher costs, CMS established two new HCPCS codes for specimen collection for COVID-19 testing:

  • G2023, specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source; and
  • G2024, specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source (85 FR 19256).

The reimbursement rate for G2023 and G2024 will be $23.46 and $25.46, respectively.

Independent laboratories may still use HCPCS codes P9603 and P9604 for travel allowance. CMS is clarifying that paper documentation of miles traveled is not required and laboratories can maintain electronic logs (85 FR 19258).

“Homebound” with regard to COVID-19 applies to those patients: (1) where a physician has determined that it is medically contraindicated for a beneficiary to leave the home because he or she has a confirmed or suspected diagnosis of COVID-19; or (2) where a physician has determined that it is medically contraindicated for a beneficiary to leave the home because the patient has a condition that may make the patient more susceptible to contracting COVID-19. A patient who is exercising “self-quarantine” is not considered to be “homebound” unless it is medically contraindicated for the patient to leave the house (85 FR 19258).

Opioid Treatment Program (OTP)

In the CY 2020 PFS final rule (84 FR 62645 and 62646), CMS finalized using interactive two-way audio/video communication technology to furnish the counseling and therapy portions of the weekly bundle of service furnished by OTPs. For the duration of the COVID-19 PHE, CMS is continuing to allow the counseling and therapy portions of the weekly bundle, as well as the add-on code for additional counseling or therapy, to be furnished using audio-only telephone calls rather than the two-way interactive audio-video communication technology (85 FR 19258).

Teaching Physicians and Moonlighting Regulations

Prior to the PHE, low and mid-level services provided in a primary care center had to be furnished under the direct supervision of a teaching physician who is immediately available. For the duration of the COVID-19 PHE, CMS is allowing all levels of E/M services to be furnished under the direct supervision of the teaching physician which may be satisfied with physical presence or via interactive telecommunications technology (85 FR 19259).

Medicare may also make payment under the PFS for teaching physician services when the resident is furnishing E/M services, interpretation of diagnostic radiology and other diagnostic tests, or psychiatry services while in quarantine, under direct supervision of the teaching physician by interactive telecommunications technology (85 FR 19259).

Lastly, CMS is allowing payment under the PFS for the services of residents that are not related to their approved GME programs and are performed in the inpatient setting of a hospital in which they have their training program as long as the resident is fully licensed to practice medicine, osteopathy, dentistry, or podiatry by the State in which the services are performed, and the services are not performed as part of the approved GME program (85 FR 19261).

Special Requirements for Psychiatric Hospitals

Existing requirements for psychiatric hospitals specify that progress notes may be recorded by the physician(s), psychologist(s), or other licensed independent practitioner(s) responsible for the care of the patient. CMS states that the term “licensed independent practitioner(s)” is outdated and may inadvertently exacerbate workforce shortage concerns and impose unnecessary regulatory burden on psychiatric hospitals. To that end, Medicare is removing the term “licensed independent practitioner(s)” under §482.61(d) of the Hospital Condition of Participation (CoPs), which will allow advanced practice providers (APPs) such as PAs, NPs, psychologists, and CNSs to document progress notes of patients receiving services in psychiatric hospitals (85 FR 19262).

Remote Physiologic Monitoring (RPM)

Prior to the PHE, remote physiologic monitoring is billable only for established patients. The CPT® codes which describe RPM services are 99091, 99453, 99454, 99457, 99458, 99473, and 99474.

For the duration of the COVID-19 PHE, CMS is allowing RPM services to be furnished to new patients in addition to established patients. Additionally, CMS is allowing the consent to receive RPM services to be obtained once annually and may be obtained at the time services are furnished. CMS suggests that the physician or other health care provider review consent information with a beneficiary, obtain the beneficiary’s verbal consent, and document the medical record that consent was obtained. Lastly, CMS is clarifying that RPM codes can be used for physiologic monitoring of patients with acute or chronic conditions (85 FR 19264).

Telephone Evaluation and Management (E/M) Services

CPT® codes used to describe E/M visits via the telephone or online are CPT® codes 98966, 98967, 98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient…) and 99441, 99442, 99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient…). Prior to the PHE, these codes were assigned a status indicator of “N” (Noncovered) under the PFS. For the duration of the COVID-19 PHE, CMS is approving separate payment under the PFS for codes 98966-98968 and 99441-99443 to facilitate a reduction in exposure risks associated with COVID-19. Additionally, CMS will not conduct reviews to determine whether or not these services were furnished to established patients during the COVID-19 PHE (85 FR 19265).

Supervision Level for Outpatient Hospital Non-Surgical Extended Duration Therapeutic Services (NSEDTS)

Non-surgical extended duration therapeutic services (NSEDTS) have a significant monitoring component that can extend over a longer period of time These services are not surgical and typically have a low risk of complications after the assessment is conducted at the beginning of the service. These services currently require a direct level of supervision at the initiation of the service, which may be followed by a general level of supervision at the discretion of the supervising physician.

For an interim period, CMS is changing the level of supervision that is required at the initiation of the NSEDTS from direct to general. General supervision, as currently defined under 42 CFR §410.27, means that the service is furnished under the physician’s overall direction and control, but the physician is not required to be present during the furnishing of the service (85 FR 19266).

National and Local Coverage Determination Requirements During the COVID-19 PHE

CMS is making the following changes, on an interim basis, to NCDs and LCDs for the duration of the COVID-19 PHE (85 FR 19266-19267):

  • The face-to-face or in-person encounter requirements for evaluations, assessments, certifications, or other implied face-to-face services, as contained in the NCDs and LCDs (including articles), will not apply except for some face-to-face encounter requirements for DMEPOS Power Mobility Devices (PMDs) that are mandated by statute.
  • Clinical Indications for Certain Respiratory, Home Anticoagulation Management and Infusion Pump Policies: CMS will not enforce the clinical indications for coverage across respiratory, home anticoagulation management, and infusion pump NCDs and LCDs. These policies include, but are not limited to:
    • NCD 240.2 Home Oxygen;
    • NCD 240.4 Continuous Positive Airway Pressure for Obstructive Sleep Apnea;
    • LCD L33800 Respiratory Assist Devices (ventilators for home use);
    • NCD 240.5 Intrapulmonary Percussive Ventilator;
    • LCD L33797 Oxygen and Oxygen Equipment (for home use);
    • NCD 190.11 Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management;
    • NCD 280.14 Infusion Pumps.; and
    • LCD L33794 External Infusion Pumps.
  • Requirements for Consultations or Services Furnished by or with the Supervision of a Particular Medical Practitioner or Specialist: For NCDs or LCDS that require a specific practitioner type or physician specialty to furnish a service, procedure or portion thereof, CMS is allowing the chief medical officer, or equivalent, of a facility to authorize another physician specialty or other practitioner type to meet these requirements. To the extent that the NCD and LCD requires a physician or physician specialty to supervise other practitioners, the chief medical officer can authorize that these supervision requirements do not apply.

Medicare Telehealth E/M Visits Level Selection

For the duration of the COVID-19 PHE, CMS is specifying that the telehealth office/outpatient E/M visit level selection may be based on medical-decision making (MDM) or time associated with the E/M on the day of the encounter. CMS is also removing any requirements regarding documentation of history and/or physical exam in the medical record (85 FR 19269).

Counting of Resident Time During the COVID-19 PHE

Prior to the PHE, regulations regarding claiming of the resident for indirect medical education (IME) and direct graduate medical education (DGME) purposes did not include provisions for a hospital to claim a resident who is performing patient care activities within the scope of his or her approved program in his or her own home or in the patient’s home. For IME and DGME purposes, CMS will allow the hospital to claim a resident, for whom they are paying the resident’s salary and fringe benefits, for the time the resident is at home or in a patient’s home if the individual is already a patient of the physician or hospital (85 FR 19269).

Inpatient Hospital Services Furnished Under Arrangements Outside the Hospital During the Public Health Emergency (PHE) for the COVID-19 Pandemic

Section 1861(b) of the Act defines routine inpatient hospital services as items and services furnished to an inpatient of a hospital to include bed and board, nursing services, use of hospital facilities, medical social services, and diagnostic or therapeutic items or services, furnished by the hospital or by others under arrangements. Therapeutic and diagnostic services are the only routine services in the hospital setting that can be provided under arrangement outside of the hospital.

CMS believes that hospitals may need to treat patient in locations outside the hospital for reasons such as limited beds and/or limited specialized equipment. For the duration of the COVID-19 PHE, CMS is allowing greater flexibility for hospitals to respond effectively to the COVID-19 pandemic by allowing hospitals to furnish routine services outside the hospital under arrangement beginning March 1, 2020 (85 FR 19278).

Advance Payments to Suppliers Furnishing Items and Services under Part B

Under §421.214, CMS has the ability to make advance payments in situations where a CMS contractor is unable to process claims within established time limits. Currently, advance payments are limited to 80 percent of anticipated claims payment based on historical claims payment data. CMS is increasing the advance payments to 100 percent of the anticipated payment for claims based on historical claims payment data. CMS is also adding criterion that suppliers in bankruptcy would not be eligible to receive advance payments (85 FR 19280).

Miscellaneous

The interim final rule contains information for which Craneware does not typically provide summarizations. We are providing the following list of items that fall in this category for your convenience:

  • Homebound Status under the Medicare Home Health Benefit (85 FR 19246-19247);
  • Telehealth Under the Medicare Home Health Benefit During the COVID-19 Pandemic (85 FR 19247-[19250);
  • Telehealth Under the Medicare Hospice Benefit During the COVID-19 Pandemic (85 FR 19250-19252);
  • Inpatient Rehabilitation Facility (IRF) Face-to-Face Requirement (85 FR 19252);
  • Removal of the IRF Post-Admission Physician Evaluation Requirement for the PHE for the COVID-19 Pandemic and Clarification Regarding the “3-Hour” Rule (85 FR 19252-19253);
  • Home Health Agency Shortage Area Requirements for Furnishing Visiting Nursing Services (85 FR 19254-19255);
  • Innovation Center Models:
    • Medicare Diabetes Prevention Program (MDPP) expanded model Emergency Policy (85 FR 19262-19263);
    • Changes to the Comprehensive Care for Joint Replacement (CJR) Model (85 FR 19263);and
    • Alternative Payment Model treatment under the Quality Payment Program (85 FR 19264).
  • Change to Medicare Shared Savings Program Extreme and Uncontrollable Circumstances Policy (85 FR 19267-19268);
  • Addressing the Impact of COVID-19 on Part C and Part D Quality Rating Systems (85 FR 19269-19275);
  • Changes to Expand Workforce Capacity for Ordering Medicaid Home Health Nursing and Aide Services, Medical Equipment, Supplies and Appliances and Physical Therapy, Occupational Therapy or Speech Pathology and Audiology Services (85 FR 19275-19276);
  • Origin and Destination Requirements Under the Ambulance Fee Schedule (85 FR 19276); and
  • Merit-based Incentive Payment System (MIPS) Updates (85 FR 19276-19280).

Action Needed

This interim final rule covers a wide-range of providers and suppliers. The portions of the interim final rule that are applicable to the type of service(s) furnished in your entity should be read in their entirety. There are multiple COVID-19 resources available via the CMS website at https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-toolkit and https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page, as well as through Craneware at https://public.craneware.com/news/covid-19-coding-and-billing.

Effective Date

01 March 2020

Background

Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020

https://www.congress.gov/bill/116th-congress/house-bill/6074

Section 1834 of the Act:

https://www.ssa.gov/OP_Home/ssact/title18/1834.htm

42 CFR 410:

https://www.govinfo.gov/app/details/CFR-1999-title42-vol2/CFR-1999-title42-vol2-part410

CY 2019 PFS Final Rule:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1693-F

CY 2020 PFS Final Rule:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1715-F

Medicare Claims Processing Manual (100-04), Chapter 16, section 10:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c16.pdf

Reference

https://www.govinfo.gov/content/pkg/FR-2020-04-06/pdf/2020-06990.pdf

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