This week, CMS issued revised payment and coverage policy for Medicare service during the COVID-19 pandemic. CMS issued a number of new policies that will be of interest to ATS members. See specific changes below.

Telehealth

• Raising the payment rate for audio-only telemedicine encounters to approximately equivalent to office and outpatient E/M services 

• Expands the universe of non-physician provider who can provide telehealth services to include physical therapists, occupational therapists, and speech language pathologists. Of note, services such as G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) and G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes, G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes are on the telemedicine list and can be performed audio only. For a complete list, see here.
• After many questions regarding the work conducted by residents, CMS restated the regulation at § 415.174(a)(3) requires that the teaching physician must not direct the care of more than four residents at a time, and must direct the care from such proximity as to constitute immediate availability (that is, provide direct supervision) and must review with each resident during or immediately after each visit, the beneficiary's medical history, physical examination, diagnosis, and record of tests and therapies

COVID19 Testing

• Medicare will no longer require a physician order for Medicare beneficiaries to get COVID-19 tests.
• Medicare and Medicaid will cover certain serology (antibody) tests, which may aid in determining whether a person may have developed an immune response and may not be at immediate risk for COVID-19 re-infection. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home.

Home health

• CMS will now allow non-physician providers to (1) order home health services; (2) establish and periodically review a plan of care for home health patients; and (3) certify and re-certify that the patient is eligible for home health services.

Teaching Hospitals

• CMS issued policy that will allow teaching hospital to increase patient beds and share resident staff to community hospitals without negatively impacting Medicare teaching hospital payment formulas.

The above policy changes are specific to COVID-19 pandemic and should not be viewed as permanent changes to CMS payment and coverage policies. Full text of the CMS announcement can be found here.

For a complete summary with highlights of the new final rule with comments, please click here. For a list of emergency waivers, please click here.