The Centers for Medicare & Medicaid Services (CMS) recently released a frequently asked questions (FAQ) document to assist Medicare providers in understanding payment parameters for COVID-19-related services. Topline takeaways from the FAQ sheet follow.
- Telehealth: CMS reiterates on p. 2 that CMS only reimburses for telehealth services furnished in a certain set of health care facilities located on rural areas. These are known as originating sites. Currently, beneficiaries are not able to receive telehealth flexibilities from their home unless under a limited set of scenarios related to treatment of substance use disorder (as authorized by the SUPPORT Act) and ESRD-related clinical assessments (as authorized by the Bipartisan Budget Act of 2018). However, in a prior fact sheet released by CMS, the agency outlines that it does reimburse for “virtual check-ins” with Medicare beneficiaries that can take place at the beneficiary’s home.
- Diagnostic Laboratory Services: Medicare Part B currently covers all medically necessary clinical diagnostic laboratory tests when ordered by a physician or other practitioner. Laboratories can bill for COVID-19 diagnostic tests through the use of two newly issued HCPCS codes for providers and laboratories to test for the virus (WHG summary on these new codes here).
- Alternative Care Sites: On p. 2, CMS explains the circumstances under which it will reimburse hospitals for providing inpatient services at a remote location. The remote location must satisfy the requirements to be provider-based to the hospital’s main campus, and must satisfy other provider-based requirements outlined in regulatory code. The FAQ also briefly outlines the steps which hospitals must take to notify CMS it has added an additional location.
- Quarantines: On p. 3-4, CMS outlines payment parameters for having to quarantine a patient based on medical necessity. First, it states that a hospital may not charge the patient a differential for a private room if the impetus for doing so is medical necessity. Moreover, patients who remain in the hospital longer than they normally would have post-discharge due to quarantine would not have to pay an additional deductible. Medicare will pay the DRG rate and any cost outliers for the patients’ entire stay until discharge.
- Drugs and Vaccines: On p. 4, CMS notes that once a vaccine for COVID-19 is available, they will be covered through the Medicare Part D benefit. In regards to Part B, the FAQ also addresses the question on whether CMS will cover a 90-day supply of drugs in the event of a pandemic when such drugs are necessary for a patient’s chronic condition. CMS states that local Medicare Administrative Contractors (MACs) have the discretion to pay for a greater-than-30-day supply of drugs. This is true specifically for immunosuppressive drugs as well, CMS notes.