Update 6.15.2020
The World Health Organization approved the following COVID-19 related diagnosis code U07.2 “COVID-19, virus not identified’ is assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available.” The Centers for Disease Control and Prevention’s National Center for Health Statistics, the US agency responsible for maintaining ICD-10-CM in the US, is monitoring the situation. The HIPAA code set standard for diagnosis coding in the US is ICD-10-CM, not ICD-10. As shown in the April 1, 2020 Addenda on the CDC website, the only new code being implemented in the US for COVID-19 is U07.1.
Once this new code U07.2 is added as an ICD-10-CM then it can be added to ABILITY’s applications.
COVID-19 code additions
UPDATE 5.6.2020
ABILITY has added the following code sets for customers to bill for COVID-19 services.
- New CPT and HCPC code announced to report Novel Coronavirus test
- 87635 (CPT) – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplitude probe technique.
- U0001 (HCPC) – CDC 2019 Novel Coronavirus (2019-ncov) real-time rt-pcr diagnostic panel
- U0002 (HCPC) – CDC 2019 Novel Coronavirus (COVID-19), any technique, multiple types or subtypes
- CMS established two Level II HCPCS codes, effective with line item date of service on or after March 1, 2020:
- G2023 – specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
- G2024 – specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source
AMA announces new codes for antibody tests
The following codes apply to ABILITY EASE All-Payer, ABILITY CHOICE and PC-ACE.
- 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
New HCPCS codes for COVID-19 testing
The following HCPC codes apply to ABILITY EASE All-Payer, ABILITY CHOICE and PC-ACE. They apply to dates of service on and after 4/14/20 and will remain active until the end of the public health emergency.
- U0003 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), 2 amplified probe technique, making use of high throughput technologies
- U0004 – 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies
Other recent topics and helpful links:
- CMS COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers
The federal government has placed blanket waivers in effect to assist hospitals (including psychiatric and Critical Access Hospitals), plus cancer centers and long-term care hospitals. Learn more at https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf
- Medicaid State Plan Fee-for-Service Payments for Services Delivered via Telehealth
CMS is promoting telehealth options in combating the COVID-19 pandemic and increasing access to care. Get details at https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-telehealth-services.pdf
- CMS General Provider Telehealth and Telemedicine Tool Kit
During the pandemic, Medicare can pay for office, hospital and other visits furnished via telehealth. A range of providers, such as doctors, nurse practitioners, clinical psychologists and licensed clinical social workers, can offer telehealth to their patients. Learn more at https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf
- RHC & FQHCs: Telehealth and Virtual Communications Flexibilities During COVID-19 Public Health Emergency
CMS has made several changes to RHC and FQHC requirements and payments to facilitate telehealth services for providers in rural areas. Learn more at https://www.cms.gov/files/document/se20016.pdf
- CMS Non-emergent, Elective Medical Services and Treatment Recommendations
Health officials have created a tiered framework to prioritize services and care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition. Learn more at https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf
- CMS COVID-19 Medicare Provider Enrollment Relief Frequently Asked Questions
Get the information you need, from how to contact your Medicare Provider Enrollment Hotline to which screening requirements CMS is waiving. View the FAQs at https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf
CMS Accelerated and Advance Payments
UPDATE 4.28.2020
On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers, effective immediately.
Funding will continue to be available to hospitals and other healthcare providers on the front lines of the coronavirus response primarily from the Provider Relief Fund.
For an updated fact sheet on the Accelerated and Advance Payment Programs, visit: https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf
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Is CMS issuing Accelerated Payment to Medicare providers during the COVID-19 pandemic?
Yes, CMS is offering an Accelerated and Advanced Payment Program to a broader group of Medicare providers to increase cash flow to providers of services and suppliers impacted by the 2019 Novel Coronavirus (COVID-19) pandemic.
The Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet.
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How do I know if I’m eligible?
There are criteria that a provider/supplier must meet to be eligible. Please review the four criteria on the CMS fact sheet.
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Who do I contact for more information regarding CMS’ Accelerated and Advanced Payment Program?
ABILITY has gathered the following links to help guide you to the Medicare Administrative Contractor (MAC) sites. Every site is different; if you have difficulties finding what you need you can contact the MAC directly.
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How do I know how much to request?
Specific amounts vary depending on the type of provider/supplier. Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period. Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100% of the Medicare payment amount for a six-month period. Critical access hospitals (CAH) can request up to 125% of their payment amount for a six-month period.
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How will these payments be repaid or recouped?
According to CMS: Accelerated/advance payments will be recovered from the receiving provider or supplier by one of two methods: 1) For the small subset of Part A providers who receive Period Interim Payment (PIP), the accelerated payment will be included in the reconciliation and settlement of the final cost report. 2) All other providers and suppliers will begin repayment of the accelerated/advance payment 120 calendar days after payment is issued.
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Am I able to use the ABILITY EASE Medicare or ABILITY EASE All-Payer applications to determine how much to request?
Contact us for a demo to see how ABILITY EASE applications can help providers navigate this process.
https://www.abilitynetwork.com/about/contact/request-a-demo/
ABILITY is continuing to monitor information from CMS and the various MACs. We will provide additional information and updates related to the CMS Accelerated and Advanced Payment process as it becomes available.
Originally posted 4.9.2020
UPDATED 4.28.2020