On March 30, 2020 it was announced that the Trump Administration has continued to make regulatory changes to better address the COVID-19 pandemic. Many of the changes will affect the way DMEPOS suppliers conduct business, including eliminating several paperwork requirements to allow physicians more time with patients and to continue to keep beneficiaries safe while providing access to care.
Remember CMS’ Patients over Paperwork initiative, that was implemented in 2017? The purpose of this plan was to reduce unnecessary regulatory burden to allow providers to concentrate on their patients. Yesterday’s announcement by the Administration is putting that plan into action. CMS announced that it will temporarily eliminate paperwork requirements to allow clinicians to spend more time with patients.
One way CMS is reducing this burden is to provide people with Medicare broader access to respiratory devices and equipment such as non-invasive ventilators, multi-function ventilators, respiratory assist devices, and continuous positive airway pressure devices. Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously, Medicare covered them under certain circumstances.
CMS has also included the following DMEPOS specific Patients over Paperwork directives:
- Where Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) is lost, destroyed, irreparably damaged, or otherwise rendered unusable, DME Medicare Administrative Contractors (MACs) have the flexibility to waive replacements requirements under Medicare such that the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency.
- Prior Authorization in DMEPOS: CMS is pausing the national Medicare Prior Authorization program for certain DMEPOS items.
- DMEPOS Accreditation: CMS is not requiring accreditation for newly enrolling DMEPOS and extending any expiring supplier accreditation for a 90-day time period.
- Signature Requirements: CMS is waiving signature and proof of delivery requirements for Part B drugs and Durable Medical Equipment when a signature cannot be obtained because of the inability to collect signatures. Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19.
- Accelerated/Advance Payments: In order to increase cash flow to providers impacted by COVID-19, CMS has expanded our current Accelerated and Advance Payment Program. An accelerated/advance payment is a payment intended to provide necessary funds when there is a disruption in claims submission and/or claims processing. CMS is authorized to provide accelerated or advance payments during the period of the public health emergency to any Medicare provider/supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the required qualifications. Each MAC will work to review requests and issue payments within seven calendar days of receiving the request. Traditionally repayment of these advance/accelerated payments begins at 90 days, however for the purposes of the COVID-19 pandemic, CMS has extended the repayment of these accelerated/advance payments to begin 120 days after the date of issuance of the payment. Providers can get more information on this process here: www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf.
In addition, CMS is providing temporary relief from many audit and reporting requirements so that providers, healthcare facilities, Medicare Advantage health plans, Medicare Part D prescription drug plans, and states can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19. This is being done by extending reporting deadlines and suspending documentation requests which would take time away from patient care.
Patients over Paperwork also extends relief to Medicare appeals in both Fee for Service (FFS), Medicare Advantage and Part D. This includes affording Medicare Administrative Contractors (MACs), Qualified Independent Contractor (QICs) in the and MA and Part D to allow extensions to file an appeal. CMS is allowing these contractors to waive requirements for timeliness for requests for additional information to adjudicate appeals and, for MA plans, extend the timeframe to adjudicate organization determinations and reconsiderations for medical items and services (but not Part B drugs) by up to 14 calendar days. These extensions are granted if: the enrollee requests the extension; the extension is justified and in the enrollee’s interest due to the need for additional medical evidence from a noncontract provider that may change an MA organization’s decision to deny an item or service; or, the extension is justified due to extraordinary, exigent, or other non-routine circumstances and is in the enrollee’s interest.
Contractors can temporarily process an appeal with incomplete Appointment of Representation forms, however, communications will only be sent to the beneficiary. Contractors can also process requests for appeal that don’t meet the required elements using information that is available. Contractors are advised by CMS to utilize all flexibilities available in the appeal process as if good cause requirements are satisfied.
Earlier in the month of March, telehealth waivers were issued to allow for patients to more easily consult with their physicians while staying safely in their homes. The Office of Civil Rights (OCR) relaxed HIPAA requirements to expand the technology used during these visits to make the process easier and more accessible for all beneficiaries. Yesterday, it was announced that an additional 80 services can be furnished via telehealth and that beneficiaries can be evaluated on audio phones.
Further expansion of telehealth allows for providers to bill for telehealth visits at the same rate as in-person visits. Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth. New as well as established patients now may stay at home and have a telehealth visit with their provider.
CMS is allowing telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health. Virtual Check-In services, or brief check-ins between a patient and their doctor by audio or video device, could previously only be offered to patients that had an established relationship with their doctor. Now, doctors can provide these services to both new and established patients.
CMS is making it clear that clinicians can provide remote patient monitoring services to patients with acute and chronic conditions and can be provided for patients with only one disease. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.
CMS continues to issue temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to this pandemic. As information is provided, we will continue to share with you on our blog. If you have any questions, feel free to contact us. Thanks for everything you are doing as healthcare providers to keep us safe!
Resources:
Durable Medical Equipment, Prosthetics, Orthotics and Supplies: CMS Flexibilities to Fight COVID-19
Posted: March 31, 2020 by van Halem Group
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