COVID-19 Articles and Resources

News and Important Information



Please NOTE: Effective Sept 02, 2022-  Ordering through the free at-home test program was suspended on Friday, September 2, because Congress hasn’t provided additional funding to replenish the nation’s stockpile of tests.

Codes and reporting guidelines are updated frequently as changes are made to meet the requirements of the COVID-19 public health emergency. Our "Coronavirus & Telehealth Coding Page" page (available to subscribers) is updated as code changes become available. Be sure to also visit payer websites frequently for changes in policies that may affect your organization. Articles, tips, and resource links can also provide additional information as well as the other links available from this topics page.

   Coronavirus & Telehealth Coding Page


                Articles and Support Pages for COVID

Current list of Codes: CMS- Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates.

New COVID Vaccine Codes Released 2021 (Sept-Oct)

Official ICD-10-CM Coding Guideline Changes Released 2021 (October)

AHIMA: FAQ's regarding ICD-10/PCS Coding for COVID-19 Revised 2020/08/05

Resources

Select the title to see a summary and a link to the full article.  some articles require a subscription to view.

CMS Updates COVID Vaccine Requirements for Staff

by  Wyn Staheli, Director of Content - innoviHealth

CMS is revising its guidance and survey procedures for all provider types related to assessing and maintaining compliance with the staff vaccination regulatory requirements. This new memorandum replaces memoranda QSO 22-07-ALL Revised, QSO 22-09-ALL Revised, and QSO 22-11-ALL Revised.

End-Stage Renal Disease Risk Model Updates for 2023

by  Aimee L. Wilcox, CPMA CCS-P CST MA MT

For the first time, ESRD Medicare beneficiaries were permitted to enroll in Medicare Advantage plans beginning in 2021. Since that time, CMS has been working to revise the program to reduce costs, improve quality, and drive benefits. Effective January 1, 2025, one such change will include a definition change for "oral-only drugs." Why is Medicare changing the definition of these drugs and how will that be a driving force in advancing care models for ESRD in the future?

Seven Major Changes Proposed by CMS in the 2023 Proposed Rule

by  Aimee L. Wilcox, CPMA CCS-P CST MA MT

As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.

CMS Encourages Medicaid MCOs and CHIP to Employ Section Waivers to Improve SDoH and Reduce Healthcare Costs

by  Aimee L. Wilcox, CPMA CCS-P CST MA MT

Over the past few years, at least 15 states have consistently pursued the goal of using social determinants of health (SDOH) in their overall healthcare analysis and treatment programs for patients, and CMS has taken notice. Data and outcomes obtained from these state programs have essentially provided an outline of how the government intends to pursue health equity through managed care contracts (MCOs) and Children's Health Insurance Program (CHIP). What is CMS seeing that they like so much and how might that affect future MCO contracts?

How CMS Determines Which Telehealth Services are Risk Adjustable

by  Aimee L. Wilcox, CPMA CCS-P CST MA MT

Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.

The Beginning of the End of COVID-19-Related Emergency Blanket Waivers

by  Aimee L. Wilcox, CPMA CCS-P CST MA MT

It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.

HHS Leaders Urge States to Maximize Efforts to Support Children’s Mental Health

by  SAMSHA Newsroom

Today, agencies across the U.S. Department of Health and Human Services (HHS) issued a joint letter to states, tribes, and jurisdictions encouraging them to prioritize and maximize their efforts to strengthen children’s mental health and well-being. The letter, signed by leaders of the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Administration for Children and Families (ACF), and the Administration for Community Living (ACL), outlines HHS’ plans to support and facilitate state-level coordination across federal funding streams to advance and expand mental health services for children.

New Audio-Only Telehealth Guidance to Meet HIPAA Rules

by  U.S. Department of Health & Human Services

Covered entities (healthcare providers and health plans) can use remote communications, called telehealth, to provide services to patients as long as they follow certain guidelines. Because certain populations may have difficulty using audio-video telehealth, HHS is now issuing this guidance on audio-only telehealth. This guidance will help ensure that individuals can continue to benefit from audio-only telehealth by clarifying how covered entities can provide telehealth services and improve public confidence that covered entities are protecting the privacy and security of patients' health information.

2022-05-26-MLNC - Biosimilars: Interchangeable Products May Increase Patient Access

by  CMS - MLNConnects

News - COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose - - Biosimilars: Interchangeable Products May Increase Patient Access - - Critical Care Evaluation & Management Services: Comparative Billing Report in May - -...

Do You Know What Code is Used to Report Long-Haul COVID-19 Conditions?

by  Aimee L. Wilcox, CPMA CCS-P CST MA MT

A new code was added to the ICD-10-CM official code set with an effective date of October 1, 2022 for reporting post-COVID-19 sequela. We have all heard about people having odd conditions following COVID-19, well now there is a code available for reporting all of these anomalies, but are you familiar with the code and the rules for reporting it?

CMS Creates New Code for Over-the-Counter COVID-19 Test

by  Raquel Shumway

COVID-19 testing coverage is expanding with a new code which became effective on April 4, 2022. From that date until the end of the COVID-19 public health emergency (PHE), Medicare is conducting a COVID-19 Test demonstration “to find out if Medicare payment for OTC COVID-19 tests will improve access to testing and result in Medicare savings or other program improvements.”

Telehealth: The Current PHE Status and What to Expect

by  Terry Fletcher, CPC CCC CEMC CCS CCS-P CMC CMSCS CMCS ACS-CA SCP-CA QMGC QMCRC

Coming soon is the possible end of the PHE. Will it be extended? How does the Consolidated Appropriations Act of 2022 impact the PHE, and where does telehealth fit into all of this? The COVID-19 public health emergency (PHE) is slated to end this week on Thursday, April...

Monitoring Changes to Telehealth in 2022

by  Aimee L. Wilcox, CPMA CCS-P CST MA MT

SUMMARY: Did you realize telehealth services increased by 11,000% between 2019-2020? Once again the newest CPT and HCPCS updates address telehealth changes for 2022 with new modifiers and guidelines for reporting. With such an increase in usage, the OIG has also identified significant fraud.

Audit News Exacerbates Healthcare Crisis

by  Ronald Hirsch, MD FACP CHCQM CHRI

No good news is not good news. Last week brought some news that may have significant financial consequences for many providers. The Health Resources and Services Administration (HRSA) program that funded care for uninsured patients with COVID-19 will run out of money and stop accepting claims on March...

2022-03-10-MLNC - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD

by  CMS - MLNConnects

News - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD - Program for Evaluating Payment Patterns Electronic Reports for Short-term Acute Care Hospitals - Quality Payment Program: 2020 Performance Information on Care Compare - Skilled Nursing Facilities: Submit Technical Expert Panel Nominations by March 16 ...

Vaccine Mandates & Your Practice

by  Wyn Staheli, Director of Content - innoviHealth

Staff vaccination requirements and who they apply to could greatly affect your organization. What does the Supreme court ruling mean for you.

Are You Keeping up with the Official ICD-10-CM Guideline Changes for COVID-19?

by  Wyn Staheli, Director of Content - innoviHealth

The COVID-19 public health emergency (PHE) has made it interesting and challenging for organizations to keep an eye on the evolving changes to the ICD-10-CM Official Guidelines for Coding and Reporting. Have you been keeping up with these changes?

Five Major ICD-10-CM Changes That Can Effect Your Organization

by  Aimee L. Wilcox, CPMA CCS-P CST MA MT

Have you had a chance to review the new ICD-10-CM codes for FY 2022? Did you know that many payers do not want to see unspecified codes when there is a possibility for better data? How adept are you at assigning and sequencing COVID-19 codes? Take a minute to review 5 of the major changes to the FY2022 ICD-10-CM code updates and claim your chance to watch our most recent webinar where we review the newest code updates.

New Codes for Pediatric COVID Vaccinations

by  Jared Staheli, MPP

On October 6, 2021, the AMA released three new codes to track COVID-19 vaccinations in the pediatric population.

New Codes for COVID Booster Vaccine & Monoclonal Antibody Products

by  Wyn Staheli, Director of Content - innoviHealth

New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
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Select the title to see a summary and a link to the full webinar information.  some webinars require a subscription to view.

Dealing with the Little Coding Conundrums 

by  Aimee L. Wilcox, CPMA CCS-P CST MA MT

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