FACILITY BILLINGAFTERTHEPHE

Modifier CS

Will no longer relieve patients of financial liability for evaluation and management charges when a practitioner orders a COVID test after 5/11/2023; patients will be responsible for the ordinary deductible and coinsurance obligations for problem-focused evaluation and management services.

Telem edicine

Delivered by billing professionals (not facilities) will continue to be an option for Medicare beneficiaries subject to Medicare?s ?List of Telehealth Services for Calendar Year 2023 " Professional fees for telehealth services will continue to be paid at the non-facility rate under the Medicare Physician Fee Schedule However, telehealth equipment must be HIPAA compliant after 5/11/2023

Hcpcs Q3014

(Telehealth originating facility fee) should no longer be reported on a facility fee claim for supporting a facility-based physician or non-physician practitioner performing a telemedicine service Hospitals may report Q3014 only if the patient comes to the facility to utilize HIPAA-compliant telehealth equipment while a distant site practitioner performs a telemedicine visit.

Telem edicine Equipm ent

During the PHE, HHSissued a temporary notice to allow covered providers to use popular non-public facing communications apps to deliver telehealth during the COVID-19 PHE, such as Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, and Skype After 5/11/2023, telehealth equipment must utilize HIPAA-secure technology, and a Business Associates Agreement must be in place with the technology provider.

Rem ot e Services Provided By Facilit ies

Will no longer be covered by Medicare (except certain mental health or substance abuse disorder treatment reported with HCPCSC7900 ? C7902 ) Some facilities took advantage of a PHEwaiver which allowed the hospital to bill for certain therapies (such as physical, occupational, speech, medical nutrition, or diabetes self-management training) over remote communications technology to patients in the home setting. This flexibility ends on May 11, 2023. (Although physical and occupational therapistsin privatepracticemayoffer servicesvia telehealth after the PHEends, hospitalswill no longer bepermitted to bill for remotefacility servicesdelivered via communicationstechnology.)

Skilled Nursing/ Sw ing Bed Coverage

Medicare?s waiver of the 3-day qualifying inpatient stay as a prerequisite for Medicare coverage of a Skilled Nursing Facility or Swing Bed care will end; coverage of skilled care/swing bed stays will again require the pre-qualifying 3-day stay All new SNFstays beginning on or after 5/12/2023 will require a qualifying hospital stay before Medicare coverage.

Enhanced DRG Paym ent s

The CARESAct provided a 20% add-on payment to IPPSDRG reimbursement for treating COVID-19 inpatients (ICD-10 diagnosis codes U07 1 or B97 27) will end for inpatients discharged after May 11, 2023. However, the new COVID-19 treatments add-on payments (NCTAP), which increase payment when specific treatments such as convalescent plasma and remdesivir are reported within the ICD-10 codes on an inpatient claim, will continue through September 30, 2023.

COVID Vaccines

Will continue to be covered in full without cost by Medicare. Medicare Advantage members and commercial health plans subject to the Affordable Care Act will continue to cover COVID vaccinations without cost, provided that the beneficiary receives care at an in-network provider. Check with the individual plan for details of coverage.

Hom e COVID Test s

Medicare beneficiaries will no longer be entitled to receive 8 home COVID tests per month per household Commercial plan coverage may vary

For more information, please visit Medicare?s FAQ document at: https://www cms gov/files/document/frequently-asked-questions-cms-waivers-flexibilitiesand -end-covid-19-public-health-emergency.pdf