Medicare Increases Payment for High-Production Coronavirus Lab Tests

This announcement made by CMS-Rulings on 14th April 2020. CMS-Rulings provide clarification and interpretation of complex or ambiguous statutory or regulatory provisions relating to Medicare, Medicaid, Utilization and Quality Control Peer Review, private health insurance, and related matters. This Ruling articulates CMS policy concerning the designation and payment of certain clinical diagnostic laboratory tests related […]

Maximizing Support to Medicaid and CHIP during COVID-19

Trump Administration on 22nd April 2020, released new tools to strip away regulatory red tape and unleash new resources to support state Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) outbreak. Because of the President’s bold action in declaring COVID-19 a national emergency, CMS now has a full suite of […]

CMS Guidance for Laboratories during COVID-19 Emergency

CMS is committed to taking critical steps to ensure America’s clinical laboratories are prepared to respond to the threat of 2019 Novel Coronavirus (COVID-19) and other respiratory illnesses to ensure reliable testing as well as ensuring patient health and safety. CMS is issuing this guidance to laboratory surveyors to provide important guidance to surveyors and […]

Re-opening Facilities to Provide Non-Emergent Non-COVID-19 Healthcare

Facilities to Provide Non-emergent Non-COVID-19 Healthcare The United States is experiencing an unprecedented public health emergency from the COVID-19 pandemic. Healthcare facilities in some areas are stretched to their limits of capacity, and surge areas have been needed to augment care for patients with COVID-19. To expand capacity to care for these patients and to […]

Adult Elective Surgery and Procedures Recommendations during COVID-19

To aggressively address COVID-19, CMS recognizes that the conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus. The following recommendations are guidance to limit non-essential adult elective surgery and medical and surgical procedures, including all dental procedures. […]

Prior authorization (PA) Policy Changes related to COVID-19

The information Prior authorization and guidance provided in this document are believed to be current and accurate at the time of posting this article. Major Medical Insurance Plans Plan Effective Date(s) Policies Aetna Check the Aetna COVID-19 Communications Update for state-specific information and detailed requirements 3/25/20 – 5/6/20 Transfers: Initial PAs waived in the following […]

Medicare Fee-for-Service (FFS) Billing for COVID-19 Specimen Collection

As part of the Public Health Emergency (PHE) for the COVID-19 pandemic and in an effort to be as expansive as possible within the current authorities to have diagnostic testing available to Medicare beneficiaries who need it, in the interim final rule with comment period, CMS is changing the Medicare Fee-for-Service (FFS) Billing rules during […]

Modifier -25 for Minor Retina Surgeries

The growth of intravitreal drug therapy for the treatment of retinal diseases over the past decade has been unprecedented. The number of intravitreal injections performed annually in the United States rose from less than 3000 in 1999 to more than 1 million in 2008, and it is estimated that more than 7 million intravitreal injections […]

Using Telehealth in Response to COVID-19

What is COVID-19? Coronavirus disease 2019 (COVID-19) is a novel coronavirus that has not been previously identified. Symptoms include cough, difficulty breathing, fever, and mild to severe respiratory illness. According to the Centers for Disease Control and Prevention (CDC), the virus currently seems to be easily spreading throughout communities in the United States (community spread), […]

FAQs on Medicare Billing for Physicians in COVID-19 Pandemic

CMS is revising certain Medicare regulations to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare program during the public health emergency (PHE) resulting from the COVID-19 pandemic. To that end, the IFC makes temporary changes to certain policies that will affect Medicare billing […]

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