Health Care Practitioner’s Guide to Navigating COVID-19: Frequently Asked Questions and Answers You Need To Know

The Coronavirus Disease (“COVID-19”) outbreak impacts everyone on the planet. The rapid speed and complexity of the pandemic creates unprecedented issues and opportunities for health care providers.  In the race to increase accessibility and affordability of care for those impacted by the virus, President Trump declared a state of emergency. While this move opens the door to accessibility, many related questions and concerns have arisen.  As health care providers work tirelessly to keep their patients safe, compliance remains a primary concern. The Johnson Pope Health Care Team continues to monitor the frequently updated guidance issued by government agencies to assist with compliance concerns related to health care.  This article is the first in a multi-part series that will address issues impacting health care providers preparing for the impact of COVID-19.

This article is intended to provide an overview of some of the emergency measures taken by the Centers for Medicare and Medicaid Services (“CMS”) and other agencies in their efforts to assist health care providers. If you have additional questions about any of these items, please contact the Johnson Pope Health Care Team. 

1. Will health care providers receive reimbursement for COVID-19 diagnostic testing and related treatments for Medicare beneficiaries?

To encourage diagnostic testing, CMS created Healthcare Common Procedure Coding System (HCPCS) codes for health care practitioners and laboratories to bill for COVID-19 diagnostic testing. As a general matter, patients are not responsible for copays and deductibles (“Cost-Sharing Obligations”) for COVID-19 diagnostic testing.

Medicare Advantage organizations may waive Cost-Sharing Obligations for COVID-19 diagnostic testing provided that such costs are waived by the provider on a uniform basis. Coverage for a COVID-19 vaccine, if created, will be required under Medicare Part D plans. In addition to coverage for diagnostic testing, medically necessary hospitalizations and telehealth visits (further described below) are also covered. 

2. What about reimbursement for COVID-19 testing for participants in Commercial and Medicaid Plans? 

On March 6, 2020, CMS published an alert that provides information related to Medicaid coverage. The alert is available on the CMS Website. However, coverage for Medicaid participants will largely vary from state to state. The Florida Medicaid Program provides coverage for COVID-19 diagnostic testing for services rendered on or after February 4, 2020. 

Many private insurance companies cover the cost of COVID-19 testing and have waived Cost Sharing Obligations and prior authorization requirements. However, private insurance company reimbursement is dependent upon the specific terms of each plan.  

3. Can telehealth be used to treat COVID-19?

CMS permits the treatment of COVID-19 via telehealth. Under existing law, Medicare reimbursement for telehealth services is limited to services provided to beneficiaries in rural areas. CMS’ emergency legislation to combat COVID-19 expands that limitation. During the state of emergency declared by President Trump, all telehealth services rendered in emergency areas (rural and non-rural emergency areas) are covered by Medicare. It is important to keep in mind that to qualify for treatment via telehealth, the Medicare beneficiary and provider must have an existing physician-patient relationship. 

Private insurance reimbursement for telehealth services varies, depending on the terms of each health care plan, and on the state in which services are rendered. 

4. Can a practitioner order early medication refills to allow for extended medication supplies, and can medications be delivered to patient homes? 

Many insurers have relaxed limitations on refills and requirements related to home delivery of prescription medications. In determining the reasonableness and necessity of relaxing refill requirements for Part B enrollees, Medicare contractors are to take into account the type of prescription. Refill requirements are also relaxed for Part D prescriptions and Medicare Advantage plans. In addition, CMS has issued guidance relaxing home delivery prohibitions for Part D and Medicare Advantage Plans. Private insurance companies have taken similar measures.  

It is important to keep in mind that although certain private insurance companies and government payors permit extended drug supplies and home deliveries, compliance with state law is still required. 

5. Will out of state providers be permitted to treat patients in states where the providers are not licensed to practice?

In general, a health care provider must be licensed in the state where patient care services are rendered. Medicare guidelines include several, related requirements. As part of the response to the pandemic, CMS waived these requirements. For example, from a Medicare enrollment and reimbursement point of view, as part of the emergency measures, a provider licensed to practice medicine in Georgia can treat a patient located in Florida for COVID-19 symptoms. It should be noted that compliance with state law is also required and state laws vary regarding this question. In emergency situations, it is not uncommon for states to similarly relax licensure requirements for out-of-state providers. Currently, by Executive Order, Florida is in a state of emergency and providers who are not licensed to practice in Florida are permitted to render COVID-19 related services to patients located in Florida.  

6. Are there guidelines for home health agencies?

CMS issued guidance recommending home health agencies screen for COVID-19. Home health agencies should pay particular attention to at-risk patients, including those patients returning from international travel, patients with COVID-19 signs or symptoms, patients exposed to COVID-19, and residents in a community with a high number of COVID-19 cases. 

7. What do nursing homes need to consider?

CMS strongly recommends nursing homes restrict visitors and nonessential personnel. CMS also recommends actively screening nursing home residents for COVID-19 symptoms, including fever and respiratory symptoms. Additional guidance for nursing homes is available in a CMS Memorandum updated on March 13, 2020. CMS also relaxed the requirement for a 3-day hospitalization to qualify for coverage at a skilled nursing facility for those in need of a transfer as a result of COVID-19.  

8. What About Patient Privacy Concerns?

We recognize that clients have many questions surrounding disclosure of patient information. We will discuss HIPAA concerns in tomorrow’s update.

As information continues to evolve during these uncertain times, we anticipate that health care concerns will remain at the forefront of the battle against COVID-19. As the situation and the law evolve, we will address other, important considerations.