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
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
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 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
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
Is CMS issuing Accelerated Payment to Medicare providers during the COVID-19 pandemic?
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.
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.
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.
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.
Am I able to use the ABILITY EASE Medicare or ABILITY EASE All-Payer applications to determine how much to request?
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