As the coronavirus spreads through the U.S., the Centers for Medicare & Medicaid Services (CMS) has released guidance for providers on billing for diagnostic tests and how Medicare will pay for emergency services.
The agency’s guidance, released late Monday, comes as testing is ramping up for the respiratory virus that has already sickened 647 Americans, according to the latest figures from the Centers for Disease Control and Prevention (CDC).
“We are receiving up-to-the-minute information about COVID-19 and are in turn, making necessary updates to our requirements and sharing that information with our providers throughout the healthcare system,” CMS Administrator Seema Verma said in a release on the guidance.
CMS’ guidance includes a frequently asked questions document (PDF) on how providers can bill and get payments for testing patients for the virus. It also details Medicare’s payment policies for lab and diagnostic services, drug and vaccine coverage and how to bill for telehealth or in-home provider services.
Last week, CMS released new diagnostic codes for providers and labs to test patients for the coronavirus. Starting next month, labs performing the test can bill Medicaid and other insurers using the new code, which only applies for tests developed by the CDC.
Local Medicare Administrative Contractors (MACs) must develop the payment amount for claims they receive from the new codes.
“Laboratories may seek guidance from the MAC on payment for these tests prior to billing for these tests,” the FAQ said. “As with other laboratory tests, there is no beneficiary cost-sharing under original Medicare.”
Major insurers have announced they are going to offer coronavirus diagnostics at no cost-sharing to customers.
The FAQ also answers questions for hospitals on what happens when a facility gets overwhelmed. One of the questions asked whether Medicare will allow payment for alternative care sites like a school gymnasium if local hospitals are almost at capacity.
“Even in the absence of an 1135 waiver, a hospital may add a remote location that provides inpatient services,” CMS said, adding the location has to meet provider requirements.
CMS also issued guidance for hospice agencies and nursing homes for ensuring infection control, as seniors are especially vulnerable to the respiratory virus. The agency recently announced that infection control will be a major focus of hospital inspections going forward.