A Quick Guide to Each Payer’s Coronavirus Changes and Waivers

Throughout the COVID-19 pandemic, commercial and government payers have issued waivers and policy changes to help physicians care for as many patients as possible. 

But each plan has different effective and expiration dates for telemedicine, testing, and treatment changes. And most commercial plans can opt in or out of government-program adjustments such as waiving cost-share for treatment. 

If you’re trying to keep track of each payer’s policies, the Texas Medical Association has created a chart that shows when each change began – and is scheduled to end – for government and commercial plans. 

The chart includes information on Medicaid and Medicare as well as Texas Department of Insurance (TDI)-regulated commercial plans and ERISA (federally regulated) policies. It is based on details posted on each plan’s website and will be updated frequently. TMA recommends you contact each patient’s plan directly. 

The chart is one of several tools TMA has published to help you navigate the constantly changing payer landscape during the pandemic. 

TMA’s Practice Viability Toolkit details multiple ways to keep your practice’s finances healthy. It includes a section on each payer’s policies. 

The webinar, Payer Updates in the Time of COVID-19, offers guidance in sorting through the inconsistent patchwork of varying COVID-19 billing and coding policies. It is accredited for 0.5 AMA PRA Category 1 Credits™. 

You can find the payer chart, toolkit, webinar, and other resources and information on the practice viability section of the TMA COVID-19 Resource Center.

POET Update 8/19/2020: BCBS Expands Telemedicine through 12/31/2020.

Be sure to open this article ( click on title) to be able to access links.

Last Updated On

May 12, 2020

Payers Extend Prior Authorization Windows During COVID-19, follow this link.

A good article on communication with patients when re-opening… and other CoVID Issues.

Today, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), launched a new COVID-19 Uninsured Program Portal, allowing health care providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020 to submit claims for reimbursement. Providers can access the portal at COVIDUninsuredClaim.HRSA.gov.

To View the File in POET InK

Follow this link:

https://www.texmed.org/Coronavirus/

As the Texas Medical Association told you Monday, personal protective equipment (PPE) will begin to move more quickly from state-managed warehouses to Texas county medical societies and on to private practice, community care physicians. Now, TMA has opened a PPE Portal for practices to submit their PPE needs.

Please visit the TMA website (https://www.texmed.org/TexasMedicineDetail.aspx?id=52910) for details.

Providers can now perform 89 telehealth services with a telephone call, CMS says

A phone call with a patient — plus complete documentation — will be all it takes to report 89 services on Medicare’s telehealth list. Practices will also be able to receive full reimbursement for 39 new services performed via telehealth according to the updated telehealth list posted today. The changes are retroactive to March 1. For the full article and list, visit the POET Ink File, CoVID-19.

From MGMA April 30, 2020 – Changes to telehealth policy:

• Following MGMA advocacy, CMS is increasing payment for audio-only telephone E/M services (CPT codes 99441-99443) such that they are paid at the same rate as similar office and outpatient E/M visits, resulting in increased payments from $14-$41 to $46-$110. CMS believes that the resources required to furnish these services during the PHE are better captured by RVUs associated with level 2-4 established office/outpatient E/M visits. CMS is not increasing payment for CPT codes 98966-98968, which are intended for practitioners that cannot separately bill for E/M. This policy is retroactive to March 1, 2020.
• For telehealth services other than CPT codes 99441-99443 and 98966-98968 (now added to the list of covered telehealth services), Medicare continues to require modalities that have both audio and video capabilities.
• CMS is forgoing its typical rulemaking process to add new services to the list of Medicare services that may be furnished via telehealth. Instead, CMS will add new telehealth services on a sub-regulatory basis to speed up the process of adding codes to the list.

HHS is delivering a second tranche of $20 billion from the Provider Relief Fund to healthcare providers impacted by COVID-19.  See the summary from MGMA.