Knowledge Base Article

MMP remains committed to continuing to monitor for COVID-19 updates specific to our reader base. This week we highlight key updates spanning from May 18th through May 26th.   

Resource Spotlight This Week:

This week’s spotlight is the CDCs COVIDView. This is a weekly surveillance summary of U.S. COVID-19 activity. Each week you can download a weekly summary. The summary includes information about the following:

Key Updates for the week,

• Virus,
• Outpatient and Emergency Department Visits,
• Severe Disease: Hospitalizations and Mortality, and
• Surveillance activity included graphs.

https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

May 18, 2020: Guidance to Safely Reopen Nursing Homes

New guidance for the safe reopening of nursing homes was announced in a CMS Press Release as part of Guidelines for Opening Up America Again. This guidance details critical steps to be taken prior to relaxing nursing home restriction including “rigorous infection prevention and control, adequate testing, and surveillance.” CMS further recommends the following steps:

• Do not advance through any phase of reopening or relax restrictions until all residents and staff have received results from a baseline test,
• Have State survey agencies inspect nursing homes experiencing a significant outbreak prior to reopening, and
• Nursing homes should remain in the current state of highest restriction and be among the last to reopen within the community.

“Nursing homes may receive visitors during phase three, which is when there has been a sustained decrease in COVID-19 cases.” This Press Release provides links to the Guidance (Memorandum QSO-20-30-NH), an FAQ document and a full list of CMS Public Health Actions for Nursing Home on COVID-19 to date.

May 19, 2020: Re-entry Guidance for Health Care Facilities and Medical Device Representatives

The release of this Guidance is a joint effort of the American Hospital Association (AHA), the Association of perioperative Registered Nurses (AORN), and the Advanced Medical Technology Association (AdvaMed).

An AdvaMed Press Release indicates that “the guidance for re-entry builds on the April 17 joint statement by AHA, AORN, the American College of Surgeons, and the American Society of Anesthesiologists – entitled “Roadmap for Resuming Elective Surgery” – with expanded, clinically based recommendations supporting the safe return of medical device representatives into health care facilities, consistent with the AdvaMed Code of Ethics. The guidance seeks to align access standards and processes across health care facilities, with principles and considerations rooted in health authority guidance, including from the CDC, FDA, and state and local authorities.”

May 19, 2020: CDC Clinical Outreach and Communication Activity (COCA) Webinar: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)

Discussion during this call included clinical characteristics of this syndrome, how cases have been diagnosed and treated, and how clinicians have been responding to recently reported cases associated with COVID-19. A video and slides from this presentation are available on the CDC website at https://emergency.cdc.gov/coca/calls/2020/callinfo_051920.asp?deliveryName=USCDC_1052-DM28705.

May 19, 2020: Special Edition MLNConnects: COVID-19: Payment for Diagnostic Laboratory Tests

“Earlier this year, CMS took action to ensure America’s patients, health care facilities, and clinical laboratories were prepared to respond to the 2019-Novel Coronavirus (COVID-19). To help increase testing and track new cases, CMS developed two HCPCS codes that laboratories can use to bill for certain COVID-19 diagnostic tests. Health care providers and laboratories may bill Medicare and other health insurers for SARS-CoV2 tests performed on or after February 4 using:  

• HCPCS code U0001 for tests developed by the Centers for Disease Control and Prevention (CDC)
• HCPCS code U0002 for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19)

Laboratories and other health providers can also bill Medicare for tests using CPT codes created by the American Medical Association, provided testing uses the method specified by each CPT code:

• CPT code 87635 for infectious agent detection by nucleic acid tests for dates of service on or after March 13
• CPT codes 86769 and 86328 for serology tests for dates of service on or after April 10

Finally, for dates of service on or after April 14, 2020, Medicare pays $100 for laboratory tests for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19 making use of high throughput technologies (PDF). Laboratories can bill Medicare for these tests using:

• U0003: 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, making use of high throughput technologies as described by CMS-2020-01-R.
• 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 as described by CMS-2020-01-R.

Neither U0003 nor U0004 should be used to bill for tests that detect COVID-19 antibodies.

For COVID-19 tests that do not use high throughput technology, Medicare Administrative Contractors developed payment amounts (PDF) for claims in their jurisdictions that will be used until we establish national payment rates though the annual laboratory meeting process. There is no cost-sharing for Medicare patients.”

May 19, 2020: Special Edition MLNConnects: COVID-19: Which Laboratory Claims Require the NPI of the Ordering/Referring Professional?

“During the COVID-19 Public Health Emergency, CMS is relaxing billing requirements for a limited number of laboratory tests (PDF) required for a COVID-19 diagnosis. Any health care professional authorized under state law may order these tests. Medicare will pay for these tests without a written order from the treating physician or other practitioner:

• If an order is not written, you do not need to provide the National Provider Identifier (NPI) of the ordering or referring professional on the claim
• If an order is written, include the NPI of the ordering or referring professional, consistent with current billing guidelines

For More Information:

• Laboratory Tests (PDF)with modified requirements

• Interim Final Rule”

May 20, 2020: COVID-19 Blanket Swing Bed Waiver for Addressing Barriers to Nursing Home Placement for Hospitalized Individuals

MLN Matters SE20018 provides answers to questions hospitals may have when looking at the option to provide post-hospital Skilled Nursing Facility (SNF) swing-bed services for non-acute care patients in your hospital. Q&A’s fall into the following topics in this eight page document:

• Swing Beds and Hospitals,
• Swing Bed Waiver during the Public Health Emergency (PHE),
• Swing Beds and the Required MDS,
• Billing and Payment for Swing Bed Services, and
• Additional Information.

May 21, 2020: FDA COVID-19 Response At-A-Glance Summary as of May 21, 2020

This document highlights the FDA’s Activities, Recent Actions and Provides links to resources for further information about COVID-19.

May 22, 2020: Alabama Medicaid Alert: COVID-19 Emergency Expiration Date Extended to June 30

The Alabama Medicaid Agency provided the following information in a May 22nd Alert:

“All previously published expiration dates related to the Coronavirus (COVID-19) emergency are once again extended by the Alabama Medicaid Agency (Medicaid). The new expiration date is the earlier of June 30, 2020, the conclusion of the COVID-19 National emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

A listing of previous Provider Alerts and notices related to the health emergency is available by selecting the Agency’s COVID-19 page in the link below:  https://medicaid.alabama.gov/news_detail.aspx?ID=13729.”

May 22, 2020: Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules

MLN Matters MM11805 provides a summary of policies in the following legislation:

• Interim Final Rule with Comment (IFC) titled “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC), and
• Medicare and Medicaid Programs, Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-129 Public Health Emergency and Delay for Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program (CMS-5531-IFC).”

The implementation date is June 12, 2020.

May 22, 2020: New OIG Work Plan Item Related to COVID-19: Audit of Nursing Home Infection Prevention and Control Program Deficiencies

The OIG announced the addition of the following new Active Work Plan Item related to COVID-19:

“The Centers for Disease Control and Prevention has indicated that individuals at high risk for severe illness from coronavirus disease 2019 (COVID-19) are people aged 65 years and older and those who live in a nursing home. Currently, more than 1.3 million residents live in approximately 15,450 Medicare- and Medicaid-certified nursing homes in the United States. As of February 2020, State Survey Agencies have cited more than 6,600 of these nursing homes (nearly 43 percent) for infection prevention and control program deficiencies, including lack of a correction plan in place for these deficiencies. To reduce the likelihood of contracting and spreading COVID-19 at these nursing homes, effective internal controls must be in place. Our objective is to determine whether selected nursing homes have programs for infection prevention and control and emergency preparedness in accordance with Federal requirements.”

The expected issue date for a report is 2020.

May 26, 2020: Transmittal 10161: Therapy Codes Update

CMS rescinded One-Time Notification Transmittal 10139, dated May 15, 2020 and has replaced it with One-Time Notification Transmittal 10161, dated May 26, 2020 to revise the implementation date for the MACs. Policies implemented in this notification are reflective of policies related to the following legislation:

• Interim final rule with comment (IFC) Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC).
• IFC Medicare and Medicaid Programs Additional Policy and Regulatory Revision in Response to the COVID-19 Public Health Emergency (CMS-5531-IFC); and
• The Coronavirus Aid, Relief, and Economic Security Act (CARES Act). This CR updates the therapy code list and associated policies effective March 1, 2020, for the duration of the COVID-19 PHE.

The revised implementation date for the MACs is June 16, 2020 and July 6, 2020 for FISS.

May 26, 2020: OIG Strategic Plan: Oversight of COVID-19 Response and Recovery

As part of their Strategic Plan, the OIG will be “using risk assessment and data analytics to identify, monitor, and target potential fraud, waste, and abuse affecting HHS programs and beneficiaries and to promote the effectiveness of HHS’s COVID-19 response and recovery programs." The plan incorporates the following four goals:

• Goal 1: Protect People,
• Goal 2: Protect Funds,
• Goal 3: Protect Infrastructure, and
• Goal 4: Promote Effectiveness of HHS Programs – Now and into the Future.