General Surgery Coding Alert

The COVID-19 public health emergency (PHE) end date is on the calendar — it’s May 11, 2023.

While some PHE waivers you’ve come to depend on have been made permanent, others are set to expire. Make sure you know the difference so you’re ready to be in compliance on May 11.

The Centers for Medicare & Medicaid Services (CMS) encourages providers to look at the change as a return to “previous health and safety standards and billing practices,” according to CMS’s Jonathan Blum, principal deputy administrator and chief operating officer, Carol Blackford, director, hospital and ambulatory policy group, and Jean Moody-Williams, deputy director of the center for clinical standards and quality, in a news release for a “Roadmap for the End the COVID-19 PHE.”

Look to Ongoing Waivers

Although many of the initial PHE-related waivers were instituted by CMS, some features, including some telehealth expansions, are being made permanent by other means.

Telehealth: “Expanding telehealth is an example of a Congressional change. The Consolidated Appropriations Act, 2021 expanded access to telehealth services … after the end of the PHE. These services have been so important to the health and well-being of Americans affected by COVID-19,” CMS says.

The waivers allow Medicare beneficiaries to access telehealth from home in place of an office visit, with no geographic restrictions, and allow certain visits to be delivered by telephone.

Private insurers will determine how they cover telehealth services once the PHE ends.

COVID-19: Medicare beneficiaries will still have access to free COVID-19 testing when ordered by a physician and performed by a lab, although providing free home tests will not continue. COVID-19 vaccines and treatments will also still be covered by Medicare when the PHE expires.

Still in play: Some aspects of care provision covered under the waivers, including some related to licensure, will defer to state law when the PHE ends. Depending on the respective state, providers may find they still have some flexibility when it comes to services they provide outside of their state of enrollment.

Similarly, regulations surrounding practitioner locations, and whether a practitioner could bill Medicare during a public emergency if practicing in a state in which they are not licensed, will defer to state law. In a fact sheet titled “Flexibilities to Fight COVID-19,” CMS says, “We originally implemented the [aforementioned] waiver out of an abundance of caution; however, it turned out that regulations that existed before the PHE allowed for a deferral to state law.”

Acknowledge These Tightened Regulations

During the PHE, CMS allowed clinicians to bill for remote physiologic monitoring (RPM) services rendered for new or established patients for both acute and chronic conditions. Once the PHE ends, clinicians must have an established relationship with the patient prior to providing these services. Additionally, right now, the RPM process as described by CPT^® codes 99453 and 99454 allows clinicians to report those codes with only two days of data. Once the PHE ends, clinicians can report those codes only if they have at least 16 days of data collected.

Staffing: CMS made some adjustments to let practices and facilities acquire and maintain personnel during the PHE, and many of these flexibilities are ending with the PHE.

One example: During the PHE, CMS temporarily modified the requirement that a supervising physician be immediately available to also include circumstances where a supervising physician had a virtual presence via real-time audio and video technology. However, this Medicare flexibility will end with the PHE.

Executives also may have less leeway in staffing decisions. When the PHE ends, the waiver that allowed the chief medical officer or equivalent leader at a hospital or facility to make staffing decisions for furnishing or supervising certain services will end. The practitioner type or physician specialty required by the National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) will again apply.

“With this information in hand, we expect that the health care system can begin taking prudent action to prepare to return to normal operations and to wind down those flexibilities that are no longer critical in nature,” CMS says.

Resources: CMS has been updating and adding regulatory changes to provider and supplier fact sheets on COVID-related waivers and flexibilities regarding which have been made permanent or will end with the PHE. Check out the following resources:

www.cms.gov/blog/creating-roadmap-end-covid-19-public-health-emergency

www. cms.gov/coronavirus-waivers

www.cms.gov/files/document/what-do-i-need-know-cms-waivers-flexibilities-and-transition-forward-covid-19-public-health.pdf.