Outpatient Facility Coding Alert - 2020 Issue 8
Reader Questions: Use COVID-19 Signifiers for 'Formal Waiver' Claims
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Article Overview
This Q&A article covers CMS guidance for Medicare Fee-for-Service claims submitted in connection with COVID-19 blanket waivers and formal waiver situations. It is aimed at Medicare billing and coding professionals, institutional and non-institutional providers, and compliance staff who need to understand the general scope of the reporting requirements discussed in CMS FAQs, the Social Security Act, and the Medicare Claims Processing Manual. The article also highlights example claim scenarios that may be affected by the guidance and points readers to CMS resources for further review.
Why This Topic Matters
It helps readers recognize when COVID-19 waiver-related Medicare claims may require special reporting markers and where CMS says to look for broader waiver guidance.
Article Sections
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Question
A reader asks about Medicare billing in connection with COVID-19-related claim reporting.
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Answer
CMS guidance is summarized along with the general setting in which the reporting markers are discussed.
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Reminder
Background on the public health emergency context, related federal authority, and the manual cited in the article.
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Examples that might impact your practice
Illustrative claim scenarios are listed to show the kinds of situations the guidance may affect.
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Best bet
A brief closing note emphasizes careful use of the reporting markers in the waiver context.
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Resources
CMS reference materials are provided for readers who want to review the underlying guidance.
What You Will Learn
- The general CMS context for Medicare claims associated with COVID-19 waiver situations.
- How the article frames reporting considerations for institutional and non-institutional providers.
- Which kinds of claim scenarios are discussed as potentially relevant to the guidance.
- Where CMS source materials on waivers and FAQs can be found.
Who Should Read This
- Medicare coders
- Billing staff
- Revenue cycle professionals
- Compliance personnel
- Institutional providers
- Non-institutional providers
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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