COVID-19 Business Intelligence and Analysis for Clinical Laboratories, Pathology Groups and Hospital Administration

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Reliable COVID-19 Business Intelligence and analysis for clinical laboratories, pathology groups and Laboratory Diagnostics.

Overview of CMS Rule Changes Allowing Flexibility for COVID-19 Testing, Telehealth, and Hospital Operations

CMS maze of rules and regulations
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Recent changes in CMS rules are intended to increase the response capabilities of providers and hospitals to the COVID-19 pandemic

The Centers for Medicare and Medicaid Services (CMS) recently released a second interim final rule. CMS-5531-IFC expands access to telehealth, increases COVID-19 testing opportunities for Medicare and Medicaid beneficiaries, and augments the healthcare workforce.

Telehealth Implications

  • CMS will increase payments for telephone evaluation and management visits to be similar to office and outpatient visit rates. These payments will be retroactive to March 1, 2020.
  • Patients receiving opioid treatment may have their periodic assessments using telehealth.
  • CMS will update the telehealth code list on a sub-regulatory basis instead of the formal rule-making process. Requests from providers will be considered in making these updates.

COVID-19 Testing Implications

  • A written order by a provider is no longer required for COVID-19 testing for Medicare payment purposes.
  • CMS will cover certain COVID-19 serology tests.
  • CMS will cover clinical laboratory processing of certain FDA-authorized tests that are self-collected at home.

Increased Flexibility for Hospitals

  • CMS will allow temporary exceptions for certain provider-based hospital outpatient departments that relocate off-campus and will continue to pay these departments under the Hospital Outpatient Prospective Payment System.
  • Providers may increase the number of beds for COVID-19 patients while receiving stable and predictable Medicare payments.
  • Certain requirements are being excepted to allow freestanding inpatient rehab facilities to accept patients from hospitals that are experiencing a surge, even if these patients do not need rehabilitation-related care.

Workforce Augmentation

  • Nurse practitioners, physician assistants, and clinical nurse specialists will be allowed to provide home health services.
  • Medicare payments will not be reduced for teaching hospitals that move their residents to other hospitals in order to meet COVID-19 related needs, and hospitals without teaching programs will not be penalized for accepting these residents.

CMS-5531-IFC builds on previously announced waivers and rules. A complete description of the effects of this new rule change can be reviewed in the CMS regulations found here. Comments must be received no later than 5 p.m., July 7, 2020.

Related Resources:


CMS-5531-IFC (Federal Register)