• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • Donate Now
  • Sign Up

Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

  • Eligibility/Enrollment
  • Coverage/Appeals
    • Medicare Costs (2021)
    • Self Help Materials – Toolkits & More
  • Topics
    • Basic Introduction to Medicare
    • COVID-19 and Medicare
    • Medicare Costs (2021)
    • Home Health Care
    • Improvement Standard and Jimmo News
    • Nursing Home / Skilled Nursing Facility Care
    • Outpatient Observation Status
    • Part B
    • Part D / Prescription Drug Benefits
    • Medicare for People Under 65
    • Medicare “Reform”
    • All Other Topics
    • Resources
      • Infographics
  • Publications
    • CMA Alerts
    • Fact Sheets & Issue Briefs
    • Infographics
    • The Medicare Handbook
    • SNF Enforcement Newsletter
    • Elder Justice Newsletter
    • Medicare Facts & Fiction
    • Articles by Topic
  • Litigation
    • Litigation News
    • Cases
    • Litigation Archive
    • Amicus Curiae Activities
  • Newsroom
    • Press Releases
    • Editorials & Letters to the Editor
    • CMA Comments, Responses, and Letters
    • Medicare Facts & Fiction
    • CMA in the News
  • About Us
    • Mission Statement
    • CMA FAQs
    • Annual Report
    • Personnel & Boards
    • The Center for Medicare Advocacy Founder’s Circle
    • Connecticut Dually Eligible Appeals Project
    • Ossen Medicare Outreach, Education and Advocacy Project
    • National Medicare Advocates Alliance
    • National Voices of Medicare Summit
    • CMA Webinars
    • Products & Services
    • Testimonials
    • Career, Fellowship & Internship Opportunities
    • Contact Us
  • Support Our Work
    • Donate Now
    • Join the Center for Medicare Advocacy Founder’s Circle
    • Take Action
    • Share Your Health Care Story
    • Tell Congress to Protect Our Care
    • Listen to Medicare & Health Care Stories
    • Sign Up

CMS Issues Clarifications on How to Obtain Additional Coverage during the Pandemic

July 9, 2020

Print Friendly, PDF & Email

The Centers for Medicare & Medicaid Services (CMS) continues to clarify instructions on authorized Medicare coverage waivers and modifications due to the COVID-19 public health emergency (PHE) through a Medicare Learning Network (MLN) publication.[1]

In a CMA Alert last month, the Center for Medicare Advocacy presented a case study that described the circumstances under which a beneficiary may qualify for an additional 100 days of coverage in a skilled nursing facility (SNF) due to the PHE.[2]

CMS has recently confirmed that “beneficiaries who do not themselves have a COVID-19 diagnosis may nevertheless be affected by the PHE.”[3] CMS clarified that if “the beneficiary is receiving the very same course of treatment as if the emergency had never occurred”, the beneficiary would not qualify for additional SNF days.[4] However, the qualification states that a “determination basically involves comparing the course of treatment that the beneficiary has actually received to what would have been furnished absent the emergency. Unless the two are exactly the same, the provider would determine that the treatment has been affected by – and, therefore, is related to – the emergency.”[5]

CMS asks providers to work with the respective Medicare Administrative Contractors (MACs) to deliver any documentation needed to establish that the COVID-19 emergency applies for the benefit period waiver.[6] CMS further instructs providers to utilize the Health Insurance Prospective Payment System (HIPPS) code that was billed when the beneficiary reached the end of the SNF benefit period.[7] CMS documents specific provider billing instructions in order to process a claim for an additional 100 benefit days in the SNF.[8]

The CMS MLN also outlines detailed instructions for providers to bill for PHE related waivers and modifications other than SNF services including the following services: inpatient psychiatric, inpatient rehabilitation, long term care hospital, critical access hospitals, neoplastic disease hospital, durable medical equipment (and prosthetic, orthotics and supplies)(DMEPOS), replacement prescription fills, community mental health centers, some end stage renal disease services, face-to-face requirements for national and local coverage determinations, some respiratory, home anticoagulation management, infusion pump and therapeutic continuous glucose monitor national and local coverage determinations, DMEPOS prior-authorization, Part B prescription drug refills, and signature requirements for proof of delivery.[9]

Beneficiaries and providers have expressed a significant amount of confusion on how to bill for these PHE-related waivers and modifications. The MLN should help to clarify those steps and help to obtain Medicare coverage for beneficiaries who qualify for services.

July 9, 2020 – K. Holt


[1] https://www.cms.gov/files/document/se20011.pdf

[2] https://medicareadvocacy.org/covid-19s-impact-on-beneficiary-rights-a-case-study-examining-medicare-coverage-exceeding-100-days-in-a-skilled-nursing-facility/

[3] https://www.cms.gov/files/document/se20011.pdf, page 11 of July 8, 2020 version of the MLN.

[4] Id.

[5] Id.

[6] Id., page 12.

[7] Id.

[8] Id., pages 12-13.

[9] Id., pages 2-6.

Filed Under: Article Tagged With: alert, COVID, COVID-19, Weekly Alert

Primary Sidebar

Easy Access to Understanding Medicare

The Center for Medicare Advocacy produces a range of informative materials on Medicare-related topics. Check them out:

  • Medicare Basics
  • CMA Alerts
  • CMA Webinars
  • Connecticut Info & Projects
  • Health Care Stories
  • Se habla Español

Sign Up for CMA Alerts

Jimmo v. Sebelius

Medicare covers skilled care to maintain or slow decline as well as to improve.

Improvement Isn’t Required. It’s the law!

Read more.

Medicare: Build Back Better

By prioritizing Medicare beneficiaries and the health systems that serve them, we can avoid drastic national consequences. The Center for Medicare Advocacy proposes a five-part plan that will make Medicare a bulwark against the worsening health and economic challenges facing the American people.

Learn more.

Latest Tweets

  • The @CDCgov's new initiative “Racism and Health” will study the impacts of social determinants on health outcomes,… https://t.co/yjpHCFftiW, 19 hours ago
@CMAorg

Footer

Stay Connected:

  • Contact Us
  • Sitemap
  • Products & Services
  • Copyright/Privacy

© 2021 · Center for Medicare Advocacy