Updates for Medicare Fee For Service (FFS): CMS MLN Matters Special Edition Article

Updates for Medicare Fee For Service (FFS): CMS MLN Matters Special Edition Article

The Centers for Medicare & Medicaid Services (CMS) has updated Special Edition (SE) MLN Matters® article SE20011 Medicare Fee for Service response. This is to address the changes made for the issuance of additional guidelines and waivers regarding the 2019 Novel Coronavirus, COVID-19 (CMS, 2020). This MLN Matters Special Edition Article is for providers and suppliers who bill Medicare Fee For-Service (FFS). This includes blanket waivers for providers and suppliers, a CMS telehealth video regarding coverage of services, guidance on Beneficiary Notice Delivery, and expansion of Ambulance origins and destination modifiers.

An updated list of blanket waivers is available on the CMS Current Emergencies resource center, including the emergency declaration blanket waivers. CMS updated this on June 5, 2020. CMS will continue to update this list as necessary (CMS, 2020).

Changes to Beneficiary Notices

CMS has updated the handling and issuance of beneficiary notices. This was due to safety concerns surrounding the treatment of patients with suspected or confirmed COVID-19. Per CMS fee for service guidelines, for issuing notices to patients who may be in isolation, anybody able to safety enter a room may drop off hard copies of notices with a beneficiary. A contact number should be provided for the beneficiary for any questions; this if the person is not able to safely deliver the notice. If this is not possible, and if the beneficiary has access to email in the isolation room, payers may deliver notices via email instead.

Off-site beneficiaries or their representatives may receive their notice delivery via telephone or secure email. To ensure compliance, the notices should include information of the delivery. This would include the name of the person delivering the notice, either via email or telephone call. Also included should be the time of call, and when/where the email notice was sent. You can find a complete list of beneficiary notices in the fee for service response affected by this change here (CMS, 2020).

Destinations for Ambulance Transport

CMS has decided to expand the list of destinations for ambulance transport during the COVID-19 Public Health Emergency (PHE). According to the revised fee for service model, Medicare will cover a medically necessary emergency or non-emergency ground ambulance transport. This will include any point of origin to a destination that is equipped to treat the patient’s condition. This is as long as it follows state and local Emergency Medical Services (EMS) protocols where the services will be provided. Additionally, CMS has included a list of modifiers. This is to account for the expanded list of destinations in the fee for service healthcare response. You can find the lists of destinations and modifiers here (CMS, 2020).

Additional Information

This is our fourth analysis article reporting on Medicare coverage of telehealth services during the PHE. These are the other three articles in this linked telehealth coverage series: “Medicare Telehealth Services Now Included in Expanded Payment Protocol,” “CMS Guidelines for Telehealth Coding & Billing During PHE,” and “Physician-Based Telehealth Policies & Regulatory Revisions.”

Additional resources on the 1135 waiver and appropriate codes, types of virtual services and providers. The reimbursement guidelines are available on the YES Blog.

To review more information about the Medicare Fee for Service response to the Coronavirus and updated MLN Matters article, visit the CMS FAQ sheet here. This also includes FAQs and billing guidelines.

YES HIM Consulting can be your organization’s resource for coding support, education, mentoring, and additional HIM needs during the COVID-19 PHE. Contact our team today to discuss how our solutions can benefit you.

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