CMS Makes Changes to Help Healthcare Providers Manage COVID-19
With so much changing, it’s critical to stay on top of the latest codes, requirements and rules from the Centers for Medicare and Medicaid Services (CMS) relating to the COVID-19 Public Health Emergency (PHE).
Here are a few of the biggest COVID-19-related announcements:
- The U.S. government enacted the Coronavirus Aid, Relief and Economic Security Act (CARES), which provides more than $100 million in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response.
- Since April 26, 2020, CMS has not accepted any new applications for the Advance Payment Program. The agency will reevaluate all pending applications for Accelerated Payments in relationship to the historical direct payments made available through HHS’s Provider Relief Fund. Significant additional funding will continue to be available to hospitals and other healthcare providers through other programs. For more information, see the fact sheet.
- In May, CMS issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as the country reopens.
To keep up with the important changes from CMS in response to COVID-19, visit the coronavirus.gov webpage. For complete and updated information specific to CMS, please visit the Current Emergencies Website.
eSolutions has also created a COVID-19 resource page to provide you with important updates, new webinars and other educational opportunities for you and your team.
CMS Waives CMN Requirement for Oxygen, Infusion Pumps
CMS has waived Certificates of Medical Necessity (CMNs) for DME oxygen equipment and DME MAC Information Forms (DIF) for external infusion pumps. Medicare beneficiaries can obtain DME oxygen equipment without a CMN for oxygen and without a DME MAC information Form (DIF) for external infusion pumps.
The CMS final interim rule published April 6 (CMS-1744-IFC) waived the clinical indication requirements for respiratory Natural Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). In the announcement, the DME MACs (Medicare Administrative Contractors) stated that the same exemption will apply to external infusion pumps. These changes will be effective until the end of the PHE.
According to DME MACs, here’s how DMEs should file oxygen (and external infusion pump) claims without a CMN:
- Continue to use the appropriate modifiers, including the KX modifier where applicable (catastrophe/disaster-related) should be added to the HCPCS code(s) billed.
- Enter “COVID-19” in the NTE 2400 (line note) or NTE 2300 (claim note) segments of the American National Standard Institute (ANSI X12) format or field 390-BM of the National Council for Prescription Drug Program (NCPDP) format. These abbreviations may also be used in Item 19 of the CMS-1500 claim form.
CMS Sets New Codes for Therapist Assistants
CMS introduced new G-codes for therapist assistants who provide maintenance programs in home health (HH) settings. This change provides HH billing and processing instructions for new G-codes that describe therapy assistant services. It also makes a correction to the processing of HH claims that receive episode sequence edits. Additionally, it makes a correction to the processing of HH claims that receive episode sequence edits.
Claims History for Outpatient, Part B, and DME, Prosthetics, Orthotics and Supplies (DMEPOS) to Be Retained for 5 years
All Medicare fee-for-service claims adjudicated through Common Working File (CWF) and accepted are stored in CWF History files. After only two years, the CWF Host purges certain claims types from CWF History. When claims are purged from CWF History, MACs and/or other shared systems rely on adding purged claims back to history using “Add History” function for adjusting and/or cancelling old claims.
CMS is directing the system(s) to expand retaining Outpatient, Part B and DMEPOS claims history for a period of up to five years or 60 months, effective as of April 1, 2020.
New CMS Toolkits
CMS released comprehensive toolkits on telehealth for general practitioners as well as additional toolkits for nursing homes and providers treating patients with End-Stage Renal Disease (ESRD).
Each toolkit provides a curated set of resources and tools for managing healthcare workforce challenges in response to the COVID-19 emergency.
CMS Issues COVID-19 Blanket Swing Bed Waiver to Address Barriers to Nursing Home Placement
In response to COVID-19, CMS has waived requirements to allow hospitals to establish Skilled Nursing Facility (SNF) swing beds payable under the SNF Prospective Payment System (PPS) to offer additional options for patients who no longer require acute care but can’t find SNF placement.
A new MLN Matters Special Edition Article SE20018 on COVID-19 Blanket Swing Bed Waiver for Addressing Barriers to Nursing Home Placement for Hospitalized Individuals (PDF) answers key questions on these waivers and offers additional qualification details.
Requests CWF to MBD Extract File Changes
CMS has requested that Common Working File (CWF) start sending the Hospice DOEBA, DOLBA dates and days used in the extract to Medicare Beneficiary Database (MBD), as well as sending a one-time extract for all beneficiaries Hospice DOEBA, DOLBA dates and days used for the past four years from the implementation date of October 5, 2020. CWF to MBD extract file changes to send hospital DOEBA, DOLBA dates and days are used to support HIPAA Eligibility Transaction System (HETS).
The Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) is the CMS system that receives and processes Medicare eligibility requests and returns Medicare eligibility and benefit details to Medicare providers. The HETS system retrieves the data it returns from the Integrated User Interface (IUI) database, which is fed with data that is initially sourced from the CWF, Enrollment Database, and Medicare Advantage Prescription Drug database. Beneficiary detail information is passed from CWF to the Medicare Beneficiary Database (MBD) via an extract file.
Currently, CWF is sending Hospice Election dates, Revocation code, Hospice Periods and National Provider Identifier (NPI) information to MBD via an extract file, but Hospice DOEBA and DOLBA dates are not included on the extract file, resulting in HETS being unable to return hospice DOEBA and DOLBA dates to Medicare providers. Medicare guidelines require sequential billing for hospice, which means Medicare providers must wait until all prior hospice billing from a provider has been completed before submitting the 81C to reflect the patient transfer. IUI does include Hospice Billing dates while HETS is missing the billing dates for any previous hospice periods, making it difficult for providers to confirm hospice sequential billing.
Update to the FQHC PPS
July 1, 2020, will mark the implementation of an update of the Prospective Payment System (PPS) for the Federally Qualified Health Center (FQHC) Pricer. The new version implements the waiving of the coinsurance for the “Families First Coronavirus Response Act.”
During the COVID-19 public health emergency (PHE), coinsurance can be waived for services that related to COVID-19 testing. For services in which the coinsurance is waived, FQHCs must put the “CS” modifier on the claim. FQHCs should not collect coinsurance from beneficiaries if they choose to waive coinsurance for services related to COVID-19 testing.
Second Update to Implementation of the Skilled Nursing Facility (SNF) PDPM Coming July 1
A second update to CR 11152 (Implementation of the SNF PDPM) will be effective July 1, 2020.
CMS is replacing Transmittal 2431, dated February 7, 2020, with Transmittal 10024 dated, April 1, 2020, to revise Business Requirement (BR) 11632.6 and delete BR 11632.7.
This Change Request (CR) implements changes to the SNF PPS, specifically implementing changes required for the Patient Driven Payment Model (PDPM). This CR applies to FISS and the CWF. It will affect SNFs’ billing on Type of Bill (TOB) 21X and hospital swing-bed providers billing on TOB 18X (subject to SNF PPS). CR 11152 erroneously made changes to some edits, forcing CMS to omit and make corrections to allow for proper claims processing. The interrupted stay policy is as follows for SNF PDPM and should only apply to SNF PPS providers: If a resident is discharged from a SNF and returns to the same SNF by the end of the third day of the interruption window, the resident’s stay is treated as a continuation of the previous stay for purposes of resident classification and the variable per diem adjustment schedule.