Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension
In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess if Congress extends the suspension; the MACs will automatically reprocess any claims paid with the reduction applied if necessary.
- Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021
- COVID-19 Vaccine Administration – No Out-of-Pocket Cost to Patients
- Alcohol Misuse: Medicare Covers Screening & Counseling
- New Provider Enrollment Administrative Action Authorities
- April 2021 Quarterly Update to HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
- Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2021
- Claims Processing Instructions for National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)
- Update to the Manual for Telephone Services, Physician Assistant (PA) Supervision, and Medical Record Documentation for Part B Services
COVID-19 Vaccine Resources: What Partners Need to Know Now
As COVID-19 vaccines continue rolling out across the country, CMS is taking action to protect the health and safety of our nation’s patients and providers and keeping you updated on the latest COVID-19 resources from HHS, CDC and CMS.
With information coming from many different sources, CMS has up-to-date resources and materials to help you share important and relevant information on the COVID-19 vaccine with the people that you serve. You can find these and more resources on the COVID-19 Partner Resources Page and the HHS COVID Education Campaign page. We look forward to partnering with you to promote vaccine safety and encourage our beneficiaries to get vaccinated when they have the opportunity. For more information, visit the CMS COVID-19 Policies and Guidance page.
FORGONE CARE DURING THE PANDEMIC
According to a recent CMS survey, many Medicare beneficiaries reported forgoing non-COVID-19 care such as regular check-ups or medical screening tests due to the pandemic. A recent CMS data analysis also showed a significant decline in service use for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, particularly for mental health and substance use disorders. With that, the number of services delivered via telehealth has significantly increased during the public health emergency.
As COVID-19 vaccines are becoming more readily available, CMS is encouraging beneficiaries to contact their health care professionals to discuss getting vaccinated, schedule any missed appointments and discuss other healthcare needs, including preventive care, screenings, and mental health services, as well as utilize telehealth services when appropriate.
If you work with CMS beneficiaries
Share the messaging below to encourage beneficiaries to take care of their health during the pandemic:
- Don’t put off necessary care, especially if it’s urgent or may lead to complications, such as heart attack or stroke.
- Continue preventive care such as immunizations and cancer screenings. Talk to your doctor about which services are right for you.
- Learn about telehealth – Many regular health care services can be handled over the phone, a portal, app, or other option. Call your doctor to ask about your options.
- Be active in your health care by taking care of yourself and your family. Exercise, diet, sleep, and relaxation are important parts of staying healthy.
- Need health insurance coverage? Visit Healthcare.gov to sign up for coverage through the Health Insurance Marketplace.
Know What Telehealth Resources are Available
CMS updated policy changes effective January 1, 2021, which included adding services to the Medicare telehealth list during the public health emergency during for the pandemic. See the fact sheet and the list of services payable under the Medicare PFS, which includes office visits, psychotherapy, consultations and other medical or health services, for more information. Providers may also find the CMS COVID-19 Vaccine Provider Toolkit helpful for coverage on administering the vaccine.
Medicaid covers some telehealth services, but coverage differs from state to state. CMS developed a Medicaid & CHIP Telehealth toolkit to help states accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs (CHIP) during the COVID-19 emergency.
In response to the increased use and expanded coverage of telehealth during the COVID-19 pandemic, From Coverage to Care (C2C) released two new resources to support providers and patients in making the most of virtual care:
Telehealth for Providers: What You Need to Know – Providers can learn how and when to use telehealth. Topics include how to set up telehealth services, how to conduct a successful visit, and how to keep up to date on telehealth payment (particularly for Medicare and Medicaid).
Telehealth: What to Know for Your Family – Patients can find out the types of care they can receive through telehealth, how to prepare for an appointment, what to expect during a visit, and more. This resource is also available in Spanish.
Providers and partners can download graphics to post on their social media channels and help spread the word about these new resources. All of these resources can be downloaded at go.cms.gov/c2ctelehealth.
For more information, please contact us at: Partnership@cms.hhs.gov