Medicare Compliance & Reimbursement

GAO continues to study long-term impact of Medicare waivers.

Navigating the pandemic highs and lows has been a critical challenge for many Medicare providers. If you are trying to plan ahead or just stay on top of the ever-changing healthcare landscape, read on for some new developments on the horizon.

1. CDC Adds Post-COVID ICD-10-CM Code for 2022

Starting on Oct. 1, you’ll have a new diagnosis code to report for post-COVID-19 conditions, according to the Centers for Disease Control and Prevention’s (CDC’s) fiscal year (FY) 2022 ICD-10-CM code set.

For patients presenting with symptoms or conditions associated with COVID-19 “that develop following a previous COVID-19 infection,” you’ll “assign a code(s) for the specific symptom(s) or condition(s) related to the previous COVID-19 infection, if known, and code U09.9 [Post COVID-19 condition, unspecified],” the ICD-10-CM guidelines indicate.

Important: You shouldn’t use U09.9 for active COVID cases. But, “if a patient has a condition(s) associated with a previous COVID-19 infection and develops a new active (current) COVID-19 infection, code U09.9 may be assigned in conjunction with code U07.1, COVID-19, to identify that the patient also has a condition(s) associated with a previous COVID-19 infection,” note the ICD-10-CM guidelines.

See CDC guidance at www.cdc.gov/nchs/icd/icd10cm.htm.

2. CDC Offers Provider Insight on Caring for Patients With ‘Long COVID’

Last month, the CDC updated its post-COVID clinical guidance for healthcare providers caring for patients with “long COVID.” Tips and tools include advice on management of post-COVID conditions and treatments; assessments and testing; therapeutics; at-home care; and more.

“Based on current information, many post-COVID conditions can be managed by primary care providers, with the incorporation of patient-centered approaches to optimize the quality of life and function in affected patients,” the guidance says.

Find the insight and assistance at www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html.

3. Feds Weigh in on COVID-19 Vaccination Boosters

If your practice and patients are worried about the hullabaloo over COVID vaccine boosters, it’s understandable with the Delta variant spiking. However, at this time, the CDC, Food & Drug Administration (FDA), and the National Institutes of Health (NIH) indicate that boosters aren’t necessary for fully vaccinated people, but they’re conducting “science-based, rigorous” research on it anyway, an FDA release says.

“Virtually all COVID-19 hospitalizations and deaths are among those who are unvaccinated,” the FDA points out. “We encourage Americans who have not yet been vaccinated to get vaccinated as soon as possible to protect themselves and their community.”

Stay tuned: Medicare Compliance & Reimbursement will continue to monitor COVID-19 vaccination changes, including booster shots and any related Medicare coding and billing updates.

4. COVID-Related FFS Billing FAQs Get More Additions

The Centers for Medicare & Medicaid Services (CMS) recently updated the COVID-19 Frequently Asked Questions (FAQs) on Medicare fee-for-service (FFS) billing. The updates include policy changes related to mass immunizers, cost-sharing requirements, monoclonal antibody treatments, and at-home vaccination administration.

View the FAQs at www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf.

Bonus: CMS also updated its COVID-19 Accelerated and Advanced Payment (CAAP) repayment and recovery FAQs. The agency doesn’t point out what’s been changed, but language, terms, and conditions pertaining to the Continuing Appropriations Act, 2021 and Other Extensions Act, have been added.

Check out the update at www.cms.gov/files/document/covid-advance-accelerated-payment-faqs-06-24-21.pdf.

5. GAO Report Reveals COVID Numbers on Telehealth Usage

If the feds were looking for a solid case for making the Medicare telehealth expansion permanent after the COVID-19 public health emergency (PHE) ends, then a quick review of research and data in a recent Government Accountability Office (GAO) report would be a good place to start.

The GAO found that the Medicare waivers and flexibilities did greatly help both providers and beneficiaries get through the worst parts of the pandemic. However, the brief suggests that the GAO is still investigating factors like the cost of extending waivers, legal implications of regulatory reform, and equity concerns; plus, more reports are expected.

For instance, a CMS Accomplishment Report suggests that telehealth utilization was at its zenith in the beginning of the PHE, GAO suggests. “Over the first 8 months of the pandemic, utilization of telehealth services in Medicare FFS sharply increased from about 325,000 services in mid-March to a peak of nearly 1.9 million services in late-April,” the report says.

But, “utilization then dropped to about 1.3 million services by the beginning of June [2020], and generally continued to slowly drop through mid-October [2020],” GAO notes.

Interesting: In its research on telehealth quality, spending, and equity, GAO breaks down Medicare beneficiaries’ telehealth usage from March 2020 to June 2020 by age, race, and location — and the statistics might surprise you. For example, only 34 percent of Medicare FFS beneficiaries aged 65-74 years old received telehealth services from March 17 to June13, 2020, according to Figure 3 of the GAO report.

Read the report www.gao.gov/assets/gao-21-575t.pdf.