Intensive Outpatient Programs
CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)
Special Edition – Friday, May 8, 2020
New Guidance Available on Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes
Nursing homes are now required to report the first week of COVID-19 data to the Centers for Disease Control and Prevention (CDC) beginning May 8 but no later than May 17. For the first time, all 15,000 nursing homes will be reporting this data directly to the CDC through its reporting tool. This reporting requirement is the first action of its kind in the agency’s history. On April 19, CMS announced the agency would be requiring facilities to report COVID-19 information to the CDC and to families. Within three weeks of that announcement, on April 30, CMS issued an Interim Final Rule with Comment Period with the new regulatory requirements. As nursing homes report this data to the CDC, we will be taking swift action and publicly posting this information so all Americans have access to accurate and timely information on COVID-19 in nursing homes.
CMS has a longstanding requirement for nursing homes to report cases of communicable diseases, such as COVID-19, to the appropriate state or local health department. This new requirement not only helps health departments intervene when needed but serves to provide awareness to the public (e.g., families) and surveillance for public health agencies and the CDC. The importance of ongoing transparency and information sharing has proven to be one of the keys to the battle against this pandemic. Building upon the successes of the Trump Administration prior to COVID-19, CMS has strongly supported transparency, such as the work done over the past several years to improve public access and understanding of nursing home inspection reports and expand the information available to consumers on Nursing Home Compare. The agency remains committed to greater transparency and plans to publicly release new data by the end of May. CMS will never stop working to give patients, residents, and families the clearest and most accurate information possible.
Telehealth Video: Medicare Coverage and Payment of Virtual Services
This updated video provides answers to common questions about the expanded Medicare telehealth services benefit under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.
Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 Testing MLN Matters® Article
A new MLN Matters Special Edition Article SE20017 on Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 Testing is available. Learn how to temporarily enroll to be an additional laboratory resource to meet the urgent need to increase COVID-19 testing capability.
COVID-19: IRF Flexibilities During the PHE
CMS is exercising regulatory flexibilities for Inpatient Rehabilitation Facilities (IRFs) during the COVID-19 Public Health Emergency (PHE) to waive the 60 percent rule.
We are also waiving IRF coverage and classification requirements if all of these criteria are satisfied:
Patient is admitted to a freestanding IRF to alleviate acute care hospital bed capacity issues
IRF is located in an area that is in Phase 1 or has not entered Phase 1; see Guidelines for Opening Up America Again
Add the following letters at the end of your unique hospital patient identification number (the number that identifies the patient’s medical record in the IRF) to identify patients eligible for each waiver:
D- 60 percent rule
DS- Coverage and classification requirements
DDS- Both 60 percent rule and coverage and classification requirements
For More Information:
COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers: See page 10 for 60 percent rule
Interim Final Rule: Coverage and classification requirements
COVID-19: IRF Interdisciplinary Team Meetings During the Pandemic
CMS expects Inpatient Rehabilitation Facilities (IRFs) to hold in-person weekly interdisciplinary team meetings to discuss Medicare Part A fee-for-service patients. During the public health emergency, it may be safest to conduct meetings electronically. We will accept all appropriate forms of social distancing precautions.
ASSISTANCE FOR PRIVATE
• NETEC PPE (COVID-19) Use and Conservation
Billing for Professional Telehealth Distant Site Services During the Public Health Emergency — Revised
This corrects a prior message that appeared in our March 31, 2020 Special Edition.
Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. When billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:
Place of Service (POS) equal to what it would have been had the service been furnished in-person
Modifier 95, indicating that the service rendered was actually performed via telehealth
As a reminder, CMS is not requiring the CR modifier on telehealth services. However, consistent with current rules for telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:
Furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology, use GQ modifier
Furnished for diagnosis and treatment of an acute stroke, use G0 modifier
There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT.
Trump Administration Issues Key Recommendations to Nursing Homes, State and Local Governments
On April 3, at the direction of President Trump, the Centers for Medicare & Medicaid Services (CMS), in consultation with the Centers for Disease Control and Prevention (CDC), issued critical recommendations to state and local governments, as well as nursing homes, to help mitigate the spread of the 2019 Novel Coronavirus (COVID-19) in nursing homes. The recommendations build on and strengthen recent guidance from CMS and CDC related to effective implementation of longstanding infection control procedures.
Billing for Multi-Function Ventilators (HCPCS Code E0467) under the COVID-19 Public Health Emergency and Otherwise
CMS recognizes that in these important times, in particular, beneficiaries, health care clinicians, suppliers, and manufacturers are looking for the broadest possible access to ventilators for their care needs. We are taking a number of steps to increase access to and remind suppliers about certain options available to them and beneficiaries regarding multi-function ventilators.
Effective immediately, CMS is suspending claims editing for multi-function ventilators when there are claims for separate devices in history that have not met their reasonable useful lifetime.
For more information on multi-function ventilators, see MLN Matters Special Edition Article SE20012.
New ICD-10-CM diagnosis code, U07.1, for COVID-19
In response to the national emergency that was declared concerning the COVID-19 outbreak, a new diagnosis code, U07.1, COVID-19, has been implemented, effective April 1, 2020.
As a result, an updated ICD-10 MS-DRG GROUPER software package to accommodate the new ICD-10-CM diagnosis code, U07.1, COVID-19, effective with discharges on and after April 1, 2020, is available on the CMS MS-DRG Classifications and Software webpage.
This updated GROUPER software package (V37.1 R1) replaces the GROUPER software package V37.1 that was developed in response to the new ICD-10-CM diagnosis code U07.0, Vaping-related disorder, also effective with discharges on and after April 1, 2020, that is currently available on the MS-DRG Classifications and Software webpage.
Providers should use this new code, U07.1, where appropriate, for discharges on or after April 1, 2020. Refer to the updated MLN Matters Articles for additional Medicare Fee-For-Service information:
For detailed information regarding the assignment of new diagnosis code U07.1, COVID-19, under the ICD-10 MS-DRGs, visit the MS-DRG Classifications and Software webpage. The announcement is located under the “Latest News” heading.
For additional information related to the new COVID-19 diagnosis code, visit the CDC website.