Part B Insider (Multispecialty) Coding Alert

Published on Tue Mar 17, 2020 PDF

 Hint: Keep on top of all the updates and requirements.

The Centers for Disease Control & Prevention (CDC) in coordination with the Department of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have been working round-the-clock to circumvent the ever-increasing threat and spread of the 2019 novel coronavirus (COVID-19) in the United States.

Details: HHS Secretary Alex Azar called a nationwide public health emergency in January. On March 11, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus pronounced COVID-19 a pandemic. This was quickly followed by the declaration of a national state of emergency for the entire United States on March 13 by President Donald Trump.

It’s hard to keep up with all the news as the feds announce changes frequently. Here’s a short list of five must-know updates to bolster your COVID-19 game plan:

1. Check the CDC daily for updates. In addition to offering a plethora of helpful tips on identifying the virus, caring for patients, and limiting the spread of COVID-19, the CDC updates daily with new guidance on preventing self-contamination amongst healthcare professionals as well as at healthcare facilities like nursing homes as the threat evolves and more cases are uncovered.

See CDC updates, including prevention videos, resources, and more at www.cdc.gov/coronavirus/2019-ncov/index.html.

2. Review new HCPCS codes for lab tests. On February 13 and March 5, CMS created two new HCPCS codes to help providers and labs address the COVID-19 outbreak.

“Starting in April, laboratories performing the test can bill Medicare and other health insurers for services that occurred after February 4, 2020, using the newly created HCPCS code (U0001). This code is only to be used for the tests developed by the Centers for Disease Control and Prevention (CDC),” stresses CMS in a fact sheet. “Laboratories performing non-CDC laboratory tests for SARS-CoV-2/2019- nCoV (COVID-19) can bill for them using a different HCPCS code (U0002).”

Plus: The agency fact sheet lists prices for the two HCPCS codes for the twelve different Medicare Administrative Contractor (MAC) jurisdictions. According to the guidance, Medicare will pay a little under $36 for HCPCS code U0001 and about $51 for HCPCS code U0002.

See the CMS pricing sheet at www.cms.gov/files/document/mac-covid-19-test-pricing.pdf.

3. Understand new Medicare guidance. Since the PHE was announced last month, CMS has been proactive with updates every day. The agency doubled down with even more changes after the national emergency declaration.

“CMS is taking immediate steps to give our nation’s providers, healthcare facilities, and states maximum flexibility,” said CMS Administrator Seema Verma in a March 13 release. “It is vital that federal requirements designed for periods of relative calm do not hinder measures needed in an emergency. The nationwide waivers we are activating today will be a godsend for those on the frontlines of the fight against this new virus.”

Top updates that Part B providers should know include:

• New coverage and billing guidance
• Waivers and flexibilities on a plethora of items
• Prior authorization updates
• Enrollment flexibilities
• Telehealth expansion
• Suspension of enforcement activities

Find all the CMS COVID-19 specific links, updates, releases and more at www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page.

4. See OCR guidance on privacy. The HHS Office for Civil Rights (OCR) issued a bulletin offering new insight on the virus, which clarifies patients’ rights and protected health information (PHI) as well as the rules that govern covered entities (CEs) during a public health emergency.

HIPAA still applies to CEs and their business associates after the feds call a PHE, and both must continue to safeguard patients’ privacy the best they can — whether in the wake of a natural disaster or the grips of a disease outbreak like COVID-19.

Reminder: If a PHE is in place, CEs can disclose patients’ PHI without authorization when it’s “necessary to treat a patient, to protect the nation’s public health, and for other critical purposes,” explains the OCR bulletin.

Get all the nitty gritty on sharing PHI during the COVID-19 threat at www.hhs.gov/sites/default/files/february-2020-hipaa-and-novel-coronavirus.pdf.

5. Watch for HHS changes every day. HHS continues to spearhead and focus its various departments on addressing COVID-19. Its many efforts include highlights like:

HHS intends to buy “500 million N95 respirators over the next 18 months for the Strategic National Stockpile (SNS)” to ensure healthcare workers are protected from the virus, notes a release. Read about the respirator coordination at www.hhs.gov/about/news/2020/03/04/hhs-to-procure-n95-respirators-to-support-healthcare-workers-in-covid-19-outbreaks.html.

HHS subsidiary Biomedical Advanced Research and Development Authority (BARDA), which is part of HHS Office of the Assistant Secretary for Preparedness and Response (ASPR), is working with industry experts to advance development on “two diagnostic tests that may detect severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in approximately one hour,” says an HHS release. Discover the details at www.hhs.gov/about/news/2020/03/13/hhs-funds-development-covid-19-diagnostic-tests.html.