New COVID vaccine rules for long-term facilities

June 22, 2021

Long-term care facilities now must provide weekly reports of staff and resident COVID-19 vaccinations to the Centers for Disease Control and Prevention’s National Healthcare Safety Network, according to an interim rule announced by the Centers for Medicare & Medicaid Services. The rule also requires that all facilities have programs in place to provide COVID-19 vaccinations to all residents and staff who wish to be vaccinated and to educate residents and staff on the benefits of COVID-19 vaccination.

The new reporting requirements are added to the existing requirements to report COVID-19 testing, cases and deaths. The reporting protocol is similar to requirements for influenza and pneumococcal vaccinations in long-term care facilities. The new interim rule also applies to intermediate-care facilities for individuals with intellectual disabilities.

More information about the interim rule can be found in the CMS announcement.

01.06.2021 COVID-19 Code Additions

ABILITY has added the following code sets for customers to bill for COVID-19 services.
These codes apply to ABILITY EASE All-Payer, ABILITY CHOICE and PC-ACE applications.

CODECPT Short DescriptorLabeler NameVaccine/Procedure NameEffective Dates
Q0239bamlanivimab-xxxxEli LillyInjection, bamlanivimab, 700 mg11.10.2020 – TBD
M0239bamlanivimab-xxxx infusionEli LillyIntravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring11.10.2020 – TBD
Q0243casirivimab and imdevimabRegeneronInjection, casirivimab and imdevimab, 2400 mg11.21.2020 – TBD
M0243casirivi and imdevi infusionRegeneronintravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring11.21.2020 – TBD
CODECPT Short DescriptorLabeler NameVaccine/Procedure NameEffective Dates
91300SARSCOV2 VAC 30MCG/0.3ML IMPfizerPfizer-Biontech Covid-19 Vaccine12.11.2020 – TBD
0001AADM SARSCOV2 30MCG/0.3ML 1STPfizerPfizer-Biontech Covid-19 Vaccine Administration – First Dose12.11.2020 – TBD
0002AADM SARSCOV2 30MCG/0.3ML 2NDPfizerPfizer-Biontech Covid-19 Vaccine Administration – Second Dose12.11.2020 – TBD
91301SARSCOV2 VAC 100MCG/0.5ML IMModernaModerna Covid-19 Vaccine12.18.2020 – TBD
0011AADM SARSCOV2 100MCG/0.5ML1STModernaModerna Covid-19 Vaccine Administration – First Dose12.18.2020 – TBD
0012AADM SARSCOV2 100MCG/0.5ML2NDModernaModerna Covid-19 Vaccine Administration – Second Dose12.18.2020 – TBD

Additional information can be found on the Centers for Medicare & Medicaid Services (CMS) website by clicking here.

CMS publishes billing info for COVID-19 vaccine administration

The Centers for Medicare & Medicaid Services (CMS) published billing guidelines for providers administering COVID-19 vaccinations. Essentially, while the vaccine is provided for free to patients and providers, you can mitigate costs by claiming reimbursement for vaccine administration. And you can do it in one of two ways:

  • Single claims
  • Roster billing

Unlike previous instances in which vaccines and other medications were covered by Medicare, you will not include the vaccine codes in your claims. For more information on how to get paid for COVID-19 vaccine administration, visit CMS’s info page on Medicare billing for COVID-19 vaccine shots.

CMS finalizes the Hospital Price Transparency rule

Hospital patients will soon have more control over their care. The Centers for Medicare & Medicaid Services (CMS) announced that the Hospital Price Transparency rule, created to empower patients and facilitate patient-driven healthcare, goes into effect January 1, 2021.

Under this rule, hospitals will be required to establish, update and make public an annual list of the hospital’s standard charges for items and services. In simple terms, it means patients will be able to more accurately estimate the cost of a hospital stay before they check in. It also allows patients to evaluate hospitals based on both quality and price.

The four main parts of this final rule include:

  • Formal definitions of “hospital,” “standard charges,” and “items and services”
  • Requirements for making information accessible to patients online
  • Communicating payer-specific negotiated charges, cash discounts, and other items affecting pricing
  • How hospitals will be monitored and/or penalized for noncompliance

Is your organization ready for the change? For more information on the rule and the requirements for compliance, visit the CMS information page.

CMS ACCELERATED AND ADVANCE PAYMENTS

Update 12.21.2020

The Centers for Medicare & Medicaid Services (CMS) announced the amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program.

Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will begin a year from the date of the provider or supplier’s payment. Previously, providers were to begin making repayments in August.

A recent CMS Newsroom article indicates that “after the first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.”

Click here to view an updated fact sheet on the Accelerated and Advance Payment Programs.

Update 12.01.2020

ABILITY has added the following code sets for customers to bill for COVID-19 services:

87636: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

87637: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

These code updates apply specifically to the ABILITY EASE All-Payer, ABILITY CHOICE and PC-ACE applications.

Additional information can be found on the American Medical Association site by clicking here and here.

Update 8.24.2020

CMS announces resumption of routine inspections of all providers and suppliers, issues updated enforcement guidance to states and posts toolkit to assist nursing homes

Click here to view the press release from CMS.

8.24.2020 Code Additions

The following new codes have been added (or are in the process of being added):

Effective DateCodeCode TypeDescription
4/10/202086318CPTImmunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip)
8/10/202086408CPTNeutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); screen
8/10/202086409CPTSARS-CoV-2 neutralizing antibody screen for SARS-CoV-2 neutralizing antibody titer
4/10/202086602CPTActinomyces antibody
4/10/202086635CPTCoccidioides antibody; for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}]
6/25/202087426CPTInfectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
5/20/20200202UHCPCInfectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
6/25/20200223UHCPCInfectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
6/25/20200224UHCPCAntibody, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed
8/10/20200225UHCPCInfectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected
8/10/20200226UHCPCSurrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum
4/1/2020G2061HCPCQualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
4/1/2020G2062HCPCQualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
4/1/2020G2063HCPCQualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

Update 8.3.2020

CMS to restart Medicare claims audits of healthcare providers on August 3

Months after suspending routine audits of Medicare claims due to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) will resume the practice August 3. Providers selected for review should discuss with their contractor any pandemic-related hardships affecting audit response timeliness.

In a four-page document of frequently asked questions, CMS noted that:

  • It will not enforce signature requirements for Medicare Fee-For-Service (FFS) reviews, Part B drugs, DME, and DMEPOS
  • The agency will enforce prior authorization and signature requirements for non-emergent medical transport
  • It will resume Review Choice Demonstration for Home Health Services in all states

In addition, any waivers and flexibilities in place at the time of the dates of service of any claims potentially selected for review will also be applied.

All U.S. nursing homes to receive point-of-care COVID-19 test kits from CMS

The nation’s 15,400 nursing homes will soon be able to conduct up to 20 COVID-19 tests per hour with rapid, on-the-spot results, according to an initiative announced this month by the U.S. Department of Health and Human Services.

The distribution of on-site tests for residents and staff will be prioritized by CMS, according to a press release that announced:

  • Each facility will receive only one diagnostic test instrument and associated tests
  • SNFs can obtain additional tests directly from test manufacturers
  • Facilities may choose to test visitors, as necessary

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:
    1. G2023 – specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
    2. 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 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 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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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