Medicare Compliance & Reimbursement

Tip: Stay in the loop as policies are changing fast.

With about 30 percent of the U.S. population fully vaccinated against COVID-19, the feds continue to churn out policies and revisions to ensure safety and compliance. Read on for the latest news you need to add to your pandemic checklist.

1. HHS Renewed the PHE for a 5th Time

On April 15, HHS Secretary Xavier Becerra extended the COVID-19 public health emergency (PHE) and its associated waivers and flexibilities for another 90 days, effective April 21, 2021. It is the PHE’s fifth renewal, coming after former HHS Secretary Alex Azar’s original Jan. 31, 2020 declaration and his renewals on April 21, 2020, July 23, 2020, Oct. 2, 2020, and, most recently, Jan. 7, 2021, the declaration reminds.

The Centers for Medicare & Medicaid Services (CMS) updated its COVID-19 blanket waivers on April 9. Date changes are in bold red while terminated policies are crossed out and also dated in red with an end date. Review the CMS update at www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf.

2. CMS Pushes 2% Sequestration Suspension Until End of 2021

Medicare fee-for-service (FFS) providers have a little more time before they need to worry about the 2 percent sequestration payment adjustment to their FFS claims. On April 14, President Biden signed H.R. 1868, extending the temporary suspension of Medicare sequestration until Dec. 31, 2021.

Rewind: The CARES Act first suspended the 2 percent sequestration from May 1, 2020 through Dec. 31, 2020. Next, under the Consolidated Appropriations Act, 2021, Congress extended the suspension again through March 31, 2021.

Medicare Administrative Contractors (MACs) are instructed to “release any previously held claims with dates of service on or after April 1” and “reprocess any claims paid with the reduction applied,” an MLN Connects indicates.

Review the new legislation at www.congress.gov/117/plaws/publ7/PLAW-117publ7.pdf.

3. OIG Targets Vaccine Billing Blunders

On April 15, the HHS Office of Inspector General (OIG) vehemently reminded COVID-19 vaccine providers that recipients are not to be charged for administration when the vaccine comes from the federal government.

Why? OIG has been fielding a plethora of patient complaints that providers are charging them for the vaccine. That’s not allowed “because the vaccine is being supplied by the federal government, [and] any provider participating in the CDC COVID-19 Vaccination Program must comply with the terms of the program and offer the vaccine to recipients for free,” relates law firm Wachler & Associates, P.C., in a blog post.

According to the OIG message, if a provider agrees to participate in the CDC program, they also agree to certain rules — on top of not charging patients for the vaccination administration. The OIG guidance indicates that organizations and providers:

• May not turn patients away for vaccinations based on insurance status;
• May not bill for an office visit for the vaccination if it’s the reason for the visit;
• May not mandate extra medical services beyond the COVID-19 shot; and
• “May not seek any reimbursement, including through balance billing, from the vaccine recipient,” notes the message.

On the converse: “Providers can, however, bill third-party payers (including Medicare and Medicaid) for administering the vaccine,” asserts partner attorney Eric D. Fader with law firm Rivkin Radler LLP in online legal analysis.

OIG continues to fervently investigate any and all fraud related to the PHE and updates its COVID-19 portal often.

Check out the OIG message at https://oig.hhs.gov/coronavirus/letter-grimm-04152021.asp and peruse the CDC program guidelines for vaccination providers at www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html.

4. J&J Vaccine Is Back in Action

After extensive safety reviews, the Centers for Disease Control and Prevention (CDC) and the Food & Drug Administration (FDA) agreed that the Johnson & Johnson (Janssen) COVID-19 Vaccine pause should be lifted, a joint statement from the agencies indicated.

Originally, the feds halted the Janssen vaccine “after reports of six cases of a rare and severe type of blood clot in individuals following administration” of the shot, the CDC and FDA say. While the vaccine was on pause, the CDC and FDA teams researched the “the risk of thrombosis involving the cerebral venous sinuses, or CVST (large blood vessels in the brain), and other sites in the body (including but not limited to the large blood vessels of the abdomen and the veins of the legs) along with thrombocytopenia, or low blood platelet counts,” explains the release. Additionally, clinicians and providers were included in the final decision making process and advised on the assessment, management, and treatment of future adverse effects.

“We have concluded that the known and potential benefits of the Janssen COVID-19 Vaccine outweigh its known and potential risks in individuals 18 years of age and older,” says Janet Woodcock, MD, acting FDA commissioner. “We are confident that this vaccine continues to meet our standards for safety, effectiveness and quality.”

Rochelle P. Walensky, MD, CDC director, agrees. “We identified exceptionally rare events — out of millions of doses of the Janssen COVID-19 administered — and we paused to examine them more carefully. As we always do, we will continue to watch all signals closely as more Americans are vaccinated.”

See the CDC and FDA joint release, which includes links to a vaccine administrator fact sheet, a patient/caregiver fact sheet, the FDA emergency use information, and a CDC alert for healthcare providers, at www.cdc.gov/media/releases/2021/fda-cdc-lift-vaccine-use.html.

5. HHS Makes COVID Vaccination a Top Priority

From funding rural campaigns to boosting vaccine equity to building confidence, the Department of Health and Human Services (HHS) is making COVID-19 vaccination a primary goal. Read on for a look at what providers need to know about the policies.

Trust: HHS is partnering with “medical experts and prominent influencers and organizations” in its “We Can Do This” initiative to educate the public on the safety and importance of vaccinating the nation, an agency release says. Guidance and toolkits are available for providers at https://wecandothis.hhs.gov/resources.

Equity: A consortium of HHS agencies are working together to ensure disabled and elderly patients have ready access to the COVID-19 vaccine with legal resources and funding. “It is crucial that states and local health authorities take affirmative steps to ensure equitable vaccine access to older adults and people with disabilities, particularly those who may face additional barriers due to race, ethnicity, income, language, or other factors,” said Alison Barkoff, acting administrator of the Administration for Community Living (ACL) in an HHS release. Find civil rights, legal, and technological resources in the HHS release at

www.hhs.gov/about/news/2021/04/13/new-legal-guidance-and-resources-to-ensure-and-expand-access-to-covid-19-vaccines-for-people-with-disabilities-and-older-adults.html.

Funding: HHS is adding an additional $150 million of American Rescue Plan funds toward bolstering “approximately 100 Health Center Program look-alikes” with grant options for providers, details an agency release. See the list of eligible applicants and apply by May 14 at https://bphc.hrsa.gov/program-opportunities/arp-funding-look-alike