Coronavirus (COVID-19) Medicare Coverage
Amidst the outbreak of the new coronavirus (COVID-19), many medical institutions are unaware of what happens with regards to coronavirus medical billing. What gets covered in this situation? Are there any things you need to put in place? We have taken reference from the CMS, and it is accurate as of March 5th, 2020.
Coverage of Coronavirus Lab Tests
Your healthcare institution can bill for tests for COVID-19. Typically, Medicare Part B will cover medically necessary clinical diagnostic laboratory tests when they’re ordered. As such, you can bill Medicare for these tests when they’re performed. CMS outlined a new Healthcare Common Procedure Coding System (HCPCS) that comes into effect in April and can be used for any tests that happened after February 4, 2020. Companies need to bill for these tests using the code U0001 – if the tests are developed by the CDC. For any tests that aren’t, the code U0002 must be used. Also, other insurers may cover COVID-19 tests, so they can be billed depending on what coverage the patient has.
Coverage for Drugs Treating Coronavirus
Any new drugs created to treat COVID-19 are covered under Medicare Part B. This includes any new antiviral drugs on the market. They will be paid by the Medicare Administrative Contractors until a new code is created. Some new drugs may be covered under Medicare Part D. In which case, they can be billed to the beneficiary’s Part D plan.
Care at Beneficiary’s Home
Many people suffering from COVID-19 will require at-home care due to a reduction in available hospital beds. As such, Medicare does pay for many of the services a doctor of NPP will have to provide in the home. This includes evaluation and management and many other services furnished in a beneficiary’s home. It’s also possible to bill for other services that aren’t face-to-face, provided they’re used to help manage the patient’s condition. This primarily includes remote patient monitoring services and communication services used to help the patient.
Coverage for Communication Technology
Medicare does cover various services that offer brief communications between patients and practitioners. Things that are covered include telephone calls, video calls, e-mail, online patient portals, and many more.
Related Article: FAQS ON MEDICARE TELEHEALTH REIMBURSEMENT DURING COVID-19
Care at Alternative Care Sites (ACSs)
During the COVID-19 outbreak, it’s possible to reach a state of emergency where hospitals can no longer provide support for patients on the main hospital premises. As such, an ACS may be set up to continue treating sick patients. Hospital beds are reserved for the critically ill, so temporary sites can be set up in school gymnasiums, etc. Hospitals can add a remote location that offers inpatient services and file an amended Form CMS 855A with its Medicare Administrative Contractor. Provided the ACS fits all the requirements, then any treatments carried out at this location can be billed.
Payment for Inpatient Prospective Payment System (IPPS) Hospitals
IPPS hospitals will continue receiving normal payment during the COVID-19 outbreak. Some hospitals have questioned whether or not there is a special Diagnostic Related Group (DRG) for this virus, but there is not. If you are paid through the IPPS, then carry on as normal.
Vaccinations for Coronavirus
As there is currently no vaccine available, this isn’t something to be concerned with, in the immediate future. However, the current law stipulates that when a COVID-19 vaccine is available, Medicare will cover it under Part D. Every single Part D plan will have to cover the vaccine when it is released.
Supply of Drugs in Pandemic Situation
COVID-19 has officially been named a pandemic by the World Health Organization. As a result, many hospitals and healthcare institutions will need to order a greater-than-30-day supply of drugs for patients. This is to cope with the increased demand and rise of patients entering the hospital. The current laws say that local Medicare Administrative Contractors (MACs) decide which drugs need to be ordered in or not. This is based on how necessary they are, how many patients need them, and much more. But, if orders are made for a 90-day supply of drugs, then they will be covered under Medicare Part B. The only exception is immunosuppressive drugs, which are generally limited to a 30-day supply. In special-case scenarios, Medicare Part B might cover a larger supply, though this is for extremely rare instances where a patient desperately needs this supply.
Payment for Ambulance
Ambulances will be more in-demand than usual during the coronavirus outbreak. As such, there are lots of questions surrounding the medical billing side of things. Right now, if an ambulance crew provides treatment but does not transport anyone or furnish the treatment from their ambulance, then these services cannot be billed to Medicare. These can only be billed if the patient is transported in the ambulance or equipment from the ambulance is used. Medicare can also be billed for all ambulance transportation costs during the COVID-19 outbreak. This will be done through the usual payment guidelines and relates to patients that are transported from home to a hospital, or from one hospital to another, or even from one hospital to a separate medical facility. If any additional equipment is required when transporting patients – such as a portable oxygen container – then this can also be covered and billed by Medicare. If the transport is already a Medicare-covered service, then it automatically will be supplied with the equipment through Medicare. If it isn’t, then payment under Medicare Part B can be made to cover the costs.