CMS Pays for Coronavirus Counseling, Other COVID-19 Billing Updates

COVID-19 billing updates

Provider reimbursement is now available to physicians who tell their patients to self-isolate at the time of COVID-19 testing, according to CMS.

An announcement released late last week in collaboration with the Centers for Disease Control and Prevention (CDC) said CMS will leverage existing evaluation and management (E/M) payment codes to reimburse eligible providers for the coronavirus counseling services, including telling patients about self-isolation and the benefits of wearing a mask at all times if they test positive for the novel coronavirus.

The reimbursement will be available to physicians in a variety of settings, CMS added, including doctor’s offices, urgent care clinics, hospitals, and community drive-thru or pharmacy testing sites, as long as counseling is provided at the time of testing.

By making reimbursement available to providers, CMS and CDC hope to stop the spread of COVID-19.

“The Centers for Disease Control and Prevention (CDC) models show that when individuals who are tested for the virus are separated from others and placed in quarantine, there can be up to an 86 percent reduction in the transmission of the virus compared to a 40 percent decrease in viral transmission if the person isolates after symptoms arise,” CMS stated.

With the number of COVID-19 cases continuing to rise, the reimbursement will incent providers to encourage their patients seeking testing for the virus to separate from others and wear a mask if their results come back positive.

“Provider counseling to patients, at the time of their COVID-19 testing, will include the discussion of immediate need for isolation, even before results are available, the importance to inform their immediate household that they too should be tested for COVID-19, and the review of signs and symptoms and services available to them to aid in isolating at home,” CMS explained.

“In addition, they will be counseled that if they test positive, to wear a mask at all times and they will be contacted by public health authorities and asked to provide information for contact tracing and to tell their immediate household and recent contacts in case it is appropriate for these individuals to be tested for the virus and to self-isolate as well,” the agency stated.

CMS also provided a checklist for providers on proper coronavirus counseling. It did not say how much providers will get paid for the services.

Additionally, CMS also recently announced the creation of new hospital procedure codes for the use of COVID-19 therapeutics.

The agency said over the weekend that it has developed and implemented new procedures codes for the use of remdesivir and convalescent plasma for treating hospitalized COVID-19 patients. The ICD-10-PCS codes went into effect on August 1st and can be reported to Medicare and other insurers to identify the use of the treatments by hospital providers.

In addition to the announcements, CMS also answered COVID-19 billing and coding questions last week, including questions on hospital billing for remote services and outpatient therapy during the pandemic.

A new question in CMS’ COVID-19 FAQs clarified that hospitals and other institutional providers cannot bill for telehealth services.

“A hospital may serve as the originating site, and can bill for an originating site facility fee for a registered hospital outpatient who is receiving a telehealth service,” CMS stated. “Billing for telehealth services is distinct from billing for hospital services and other institutional services, and in most circumstances occurs using professional claims, not institutional claims that would be submitted by the hospital or other institutional provider.”

Updated FAQs on hospital billing of remote services also addressed how hospitals can ensure when a beneficiary’s home qualifies as a provider-based department of a hospital, a condition necessary for Medicare fee-for-service payment for the remote service; when a hospital can bill for the originating site facility fee for remote hospital outpatient clinic visits; and whether hospitals can furnish services remotely without a Medicare-enrolled professional billing.

CMS also clarified how hospitals should bill for outpatient therapy services furnished via telehealth during the COVID-19 public health emergency, as well as how hospitals can bill Medicare for outpatient therapy services furnished by employed or contracted therapists using telecommunications technology.

Utilization of remote services has skyrocketed since the start of the pandemic when healthcare organizations stopped elective procedures to stop the spread of COVID-19.

While many communities are opening back up, hospitals and other providers are still leveraging telehealth and remote patient monitoring to keep COVID-19 rates down and accommodate social distancing recommendations.

There are also new sections in the document on whether hospitals can bill for and get a separate payment for COVID-19 testing services rendered in the outpatient department before an inpatient admission; the application of cost-sharing modifiers to pre-survey testing services that include COVID-19 testing; and the identification of episodes of care for use of adjusting Medicare Shared Savings Program calculations.

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