On August 26, 2020, the Centers for Medicare and Medicaid (CMS) released an updated Frequently Asked Questions (FAQ) guide for questions related to COVID-19 and the public health emergency (PHE). The guide supplements the previously released FAQ guidance pertaining to 1135 Waivers under COVID-19. The new guide includes additional details from COVID-19 legislation, emergency rules, and waivers. The policies included in the FAQ are effective for the duration of the PHE unless superseded by future legislation.
The FAQs address provisions from the Coronavirus Aid, Relief, and Economic Security (CARES) Act, as well as the two interim final rules: the Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COIVD-19 Public Health Emergency and Medicare and Medicaid Programs, Basic Health Program and Exchanges: Additional policy and Regulatory Revisions in Response to the COIVD-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program.
The guidance covers a variety of topics related to COVID-19 testing including:
- payment for specimen collection for COVID-19 testing, and
- detailed coding information for COVID-19 laboratory testing, and diagnostic laboratory services.
The guidance also includes FAQs on issues related to hospital services during the PHE, such as:
- temporary expansion sites, repurposing areas of hospitals, and Ambulatory Surgery Centers (ASCs) enrolling as hospitals.
The FAQs also address key issues regarding Medicare Condition of Participation waivers, Medicare cost reports, how Medicare is reimbursing for beneficiaries that must be isolated due to COVID-19, and issues related to Medicare billing and claims processing for transfers during COVID-19.
Changes made to the hospital inpatient prospective payment system (IPPS) under the CARES Act are also explained in the FAQs including increased payments, discharge of COVID-19 patients and claims processing updates. The guide contains FAQs regarding on-campus and excepted off-campus provider based departments (PBDs) under the COVID-19 PHE.
Telehealth remains a key focus and the guidance addresses additional changes applicable to telehealth, such as:
- whether mental health visits can be furnished as a distant site telehealth service;
- whether a medical visit and a mental health visit can be reported on the same day when furnished as a distant site telehealth service; and
- how to report distant site telehealth services when a mental health visit is furnished on the same day as a medical visit;
- which services can be provided by telehealth during a waiver for the PHE;
- whether practitioners can provide Medicare telehealth services using video-enabled phones; and
- if the video connection is disconnected during an audio-video Medicare telehealth visit due to technological issues, whether the visit can still be billed as Medicare telehealth.
The guidance also covers physician services and scope of practice issues that changed under the COVID-19 PHE. In addition, additional flexibilities provided under the teaching physician regulations during the COVID-19 PHE are addressed in the guidance.
Other topics covered include:
- Hospital Outpatient Therapeutic Services Furnished in Temporary Expansion Locations
- Partial Hospital Program (PHP) Services
- Ambulance Services
- Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), including expansion of virtual communication services for FQHCs and RHCs
- Durable Medical Equipment Interim Pricing in the CARES Act
- Home Infusion Services
- Medicare Shared Savings Program Accountable Care Organizations (ACOs)
- Cost Reporting/How to Report Relief Fund Payments on the Cost Report
- Skilled Nursing Facility Services
- General Billing Requirements
- Home Health
- Part B Drugs and Vaccines
- National Coverage Determinations (NCDs)
- Medicare Payment to Facilities Accepting Government Resources
- Temporary Department of Defense Sites
- Ambulatory Surgical Centers (ASCs)
- Chronic Care Management Services
- Hospital Billing for Remote Services
- Diagnosis Coding under International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
- Outpatient Therapy Services
It is imperative that providers understand and remain abreast of updated guidance issued by CMS to ensure compliance with the COVID-19 legislation, emergency rules, and waivers. We are continuing to monitor Medicare changes during the COVID-19 PHE and will provide additional guidance as it becomes available.