Knowledge Base Article

This week we highlight key updates spanning from March 31st through April 5th of 2021.

Resource Spotlight: Medicare COVID-19 Data Snapshot Updated March 24,2021

The Medicare COVID-19 Data Snapshot provides summary data and visuals from Medicare Fee-for-Service (FFS) claims data, Medicare Advantage (MA) plans encounter data, and Medicare enrollment information.

COVID-19 cases and hospitalization are identified by ICD-10-CM codes:

·        B97.29 from January 1st through March31st 2020, and

·        U071 effective April 1, 2021 forward.

The most recent update to the Data Snapshot represents claims data from January 1, 2020 through December 26,2020. As of late 2020 around 63.1 million Americans are enrolled in Medicare with 60% in Medicare FFS, and 40% in MA plans. CMS cautions that data is preliminary as there is always a “claims lag” between services provided and when the claim is in the database.  With that in mind the specific dates of service includes claims received by January22, 2021.

Since the last Data Snapshot release:

·        For the first time since CMS began publishing the Data Snapshot, rural cases of COVID-19 (4,271 per 100,000) is higher than in urban areas (4,151 per 100,00),

·        Medicare FFS spending associated with COVID-19hospitals grew to $10.3 billion, and

·        Hypertension remains the most prevalent chronic condition among Medicare FFS COVID-19 hospitalized beneficiaries at 78%.

You can read more about the recent Data Snapshot update in a related CMS Press Release.

April 1, 2021:  Advancements in Over-the-Counter (OTC) Tests for COVID-19

The FDA announced they had taken “swift action this week to get more tests for screening asymptomatic individuals on the market” by authorizing three tests with serial screening claims. They go on to note these tests had already been authorized for use by the agency to test individuals with COVID-19 symptoms, but this week’s authorization is for testing asymptomatic individuals when used for serial testing.

April 1, 2021: Repayment of COVID-19 Accelerated and Advance Payments began March 30, 2021

CMS published MLN article SE21004 on April 1stto inform all Medicare providers and suppliers who requested and receivedCOVID-19 Accelerated and Advance Payments (CAAPs) that they began recovering those payments as early as March 30, 2021. Also included in the article is information on how to identify recovered payments.

Additional information including a Press Release, Fact Sheet and Frequently Asked Questions is available on the CMS COVID-19 Accelerated and Advance Payments webpage.

April 1, 2021: No Out-of-Pocket Costs to Patients for COVID-19 Vaccine Administration

Currently, the United States Government has purchased all COVID-19 vaccine in the U.S. for administration exclusively by enrolled providers through the CDC COVID-19 Vaccination Program.The Thursday April 1, 2021 edition of the CMS MLN Connects newsletter includes the following reminders for participants in this program:

“If you participate in the CDC COVID-19 Vaccination Program, you must:

·        Administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine

·        Vaccinate everyone, including the uninsured,regardless of coverage or network status

You also can’t:

·        Balance bill for COVID-19 vaccinations

·        Charge your patients for an office visit or other fee if COVID-19 vaccination is the only medical service given

·        Require additional medical or other services during the visit as a condition for getting a COVID-19 vaccination

Report any potential violations of these requirements to the HHS Office of the Inspector General:

·        Call 1-800-HHS-TIPS

·        Submit an online complaint

Submit claims for administering COVID-19 vaccines to:

·        Medicare, if your patient has Medicare Part B coverage or, for 2020 and 2021, Medicare Advantage (Part C)

·        Private insurance company (PDF), including if your patient only has Medicare Part A coverage with supplemental coverage from a private insurer  

·        Your state’s Medicaid program for patients with Medicaid and Children’s Health Insurance Program (CHIP) coverage

·        Health Resources & Services Administration (HRSA) COVID-19 Uninsured Program ,including if your Medicare patient only has Part A coverage with no supplemental coverage”

April 2, 2021: International Travel During COVID-19 – CDC Guidance Updated

The CDC has updated their guidance regarding international travel during COVID-19 to note that “fully vaccinated travelers are less likely to get and spread COVID-19. However, international travel poses additional risks and even fully vaccinated travelers are at increased risk for getting and possibly spreading new COVID-19 variants. CDC recommends delaying international travel until you are fully vaccinated.” The update also includes tips for getting tested after travel and self-quarantining.

April 5, 2021: Acute Hospital Care at Home Program List of Approved Hospitals Updated

This program is an expansion of the CMS Hospitals Without Walls Initiative launched over a year ago now in March 2020. CMS once again updated the list of approved hospitals. The updated list also includes a note that this list will be moving to the CMS Hospital at Home webpage beginning April 9, 2021.