Thursday, May 7, 2020
- CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes
- Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify
- Health Care Supply Chain, Provider Self-Care, and Emergency Preparedness Resources
- COVID-19: Modified Ordering Requirements for Laboratory Billing
- Hospital OPPS: New Coronavirus Specimen Collection Code
- Addition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635
- Modify Edits in the Fee for Service (FFS) System when a Beneficiary has a Medicare Advantage (MA) Plan
- New Codes for Therapist Assistants Providing Maintenance Programs in the Home Health Setting
- Updates to Ensure the Original 1-Day and 3-Day Payment Window Edits are Consistent with Current Policy — Revised
View this edition as PDF (PDF)
News
CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes
Commission will comprehensively examine best practices in responding to COVID-19 in nursing homes
As a part of President Trump’s Opening Up America Again effort, the Centers for Medicare & Medicaid Services (CMS) announced a new independent Commission that will conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic. The Commission will provide independent recommendations to the contractor to review and report to CMS to help inform immediate and future responses to COVID-19 in nursing homes. This unprecedented effort builds upon the agency’s five-part plan unveiled last April to ensure safety and quality in America’s nursing homes, as well as recent CMS efforts to combat the spread of COVID-19 within these facilities. May 1 marks the beginning of Older Americans Month and, as we take this time to honor seniors, CMS remains committed to enacting policies that benefit our Nation’s seniors.
Press release
Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify
Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections 1814(a) and 1835(a) of the Social Security Act to allow Nurse Practitioners (NPs), certified Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) to certify beneficiaries for eligibility under the Medicare home health benefit and oversee their plan of care. This is a permanent change that will continue after the Public Health Emergency.
Effective for claims with dates of service on or after March 1, 2020, these non-physician practitioners may bill the following codes:
- G0179: Physician re-certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care
- G0180: Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care
- G0181: Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans
The descriptors of the three codes will be revised at a later date to include the non-physician practitioner specialties.
Health Care Supply Chain, Provider Self-Care, and Emergency Preparedness Resources
The most recent Express from the Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) highlights recently developed resources, including:
- Stress Management Exercise for Health Care Workers Responding to COVID-19: Manage stress before, during, or after your shift
- Crisis Standards of Care during COVID-19: Speakers share their experiences and practical considerations for state health departments and hospital systems related to the ethical application of crisis standards of care
- COVID-19 Clinical Rounds Peer-to-Peer Virtual Communities of Practice: Interactive virtual learning sessions aim to create a peer-to-peer learning network where clinicians from the U.S. and abroad who have more experience treating patients with COVID-19 share their challenges and successes
- COVID-19 Alternate Care Site Resources: Collection addresses capacity and capability gaps and includes a toolkit, video, and fact sheet
- COVID-19 Health Care Workforce Virtual Toolkit: Links to tools and resource collections related to health care workforce issues, from licensure and scope of practice expansions, to training, protection, and resiliency resources for health care workers
For More Information:
- ASPR TRACIE Fact Sheet
- ASPR TRACIE website
- ASPR TRACIE Novel Coronavirus Resources webpage
Claims, Pricers & Codes
COVID-19: Modified Ordering Requirements for Laboratory Billing
During the COVID-19 Public Health Emergency, CMS is relaxing billing requirements for laboratory tests (PDF) required for a COVID-19 diagnosis. Any health care professional authorized under state law may order tests. Medicare will pay for tests without a written order from the treating physician or other practitioner:
- If an order is not written, an ordering or referring National Provider Identifier (NPI) is not required 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
Hospital OPPS: New Coronavirus Specimen Collection Code
To identify and pay for specimen collection for COVID-19 testing, CMS established a new Level II HCPCS code for billing Medicare under the Outpatient Prospective Payment System (OPPS).
The new code, C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source, is effective for services provided on or after March 1, 2020.
OPPS claims received on or after May 1, 2020, with Coronavirus Specimen Collection HCPCS Codes G2023 and G2024 will be returned to you with edit W7062. Resubmit returned claims as a packaged service to include Code C9803, when appropriate.
Events
COVID-19: Office Hours Call — May 7
Thursday, May 7 from 5 to 6 pm ET
Hospitals, health systems, and providers: Ask CMS questions about our temporary actions that empower you to:
- Increase hospital capacity – CMS Hospitals Without Walls
- Rapidly expand the health care workforce
- Put patients over paperwork
- Promote telehealth
To Participate:
- Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
- Or, call 833-614-0820; Access Passcode: 1181167
For More Information:
- Coronavirus.gov
- CMS Current Emergencies website
- Podcast and Transcripts webpage: Audio recordings and transcripts
Target Audience: Hospitals, health systems, and providers.
COVID-19: Lessons from the Front Lines Calls — May 8
Friday, May 8 from 12:30 to 2 pm ET
These weekly calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians: Share your experience, ideas, strategies, and insights related to your COVID-19 response. There is an opportunity to ask questions.
To Participate:
- Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
- Or, call 877-251-0301; Access Code: 9146779
For More Information:
- Coronavirus.gov
- CMS Current Emergencies website
- Podcast and Transcripts webpage: Audio recordings and transcripts
Target Audience: Physicians and other clinicians.
MLN Matters® Articles
Addition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635
A new MLN Matters Article MM11765 on Addition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635 (PDF) is available. Learn about the addition of codes for COVID-19.
Modify Edits in the Fee for Service (FFS) System when a Beneficiary has a Medicare Advantage (MA) Plan
A new MLN Matters Article MM11580 on Modify Edits in the Fee for Service (FFS) System when a Beneficiary has a Medicare Advantage (MA) Plan (PDF) is available. Learn about Part A services when an MA plan becomes effective during inpatient admission.
New Codes for Therapist Assistants Providing Maintenance Programs in the Home Health Setting
A new MLN Matters Article MM11721 on New Codes for Therapist Assistants Providing Maintenance Programs in the Home Health Setting (PDF) is available. Learn about new G-codes that describe therapy assistant services.
Updates to Ensure the Original 1-Day and 3-Day Payment Window Edits are Consistent with Current Policy — Revised
A revised MLN Matters Article MM11559 on Updates to Ensure the Original 1-Day and 3-Day Payment Window Edits are Consistent with Current Policy (PDF) is available. This Article was revised to update the change request information.
Publications
Evaluation and Management Services — Revised
A revised Evaluation and Management Services Medicare Learning Network Guide is available. Learn about:
- Documentation
- Billing
- Coding
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