Carta Circular 20-021 & ANEJOS

In: Circulares, Noticias


Carta Circular 20-021
CAMBIO DE FECHA PARA EL COMIENZO DEL PORTAL DE INSCRIPCIÓN DE PROVEEDORES DEL PROGRAMA MEDICAID DE PUERTO RICO 


Carta Circular 20-021 | ANEJO
Carta Programa Medicaid PR Español


Carta Circular 20-021 | ANEJO
Carta Programa Medicaid PR – English


Carta Circular 20-021 | ANEJO
Itinerario Adiestramiento e Inscripción Actualizado

By: Ray

Carta Circular 20-019 ENMENDADA

In: Circulares, Noticias


Carta Circular 20-019 ENMENDADA
PERIODO DE EMERGENCIA COVID-19
Códigos para servicios de consulta virtual o telefónica, telemedicina y seguimiento a pacientes durante COVID-19

By: Ray

COVID-19: Telehealth Video, Coinsurance and Deductible Waived & More

In: Comunicados, Eventos, Noticias

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

Special Edition – Tuesday, April 7, 2020

 


New Video Available on Medicare Coverage and Payment of Virtual Services

CMS released a video providing answers to common questions about the Medicare telehealth services benefit. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Video


Families First Coronavirus Response Act Waives Coinsurance and Deductibles for Additional COVID-19 Related Services

The Families First Coronavirus Response Act waives cost-sharing under Medicare Part B (coinsurance and deductible amounts) for Medicare patients for COVID-19 testing-related services. These services are medical visits for the HCPCS evaluation and management categories described below when an outpatient provider, physician, or other providers and suppliers that bill Medicare for Part B services orders or administers COVID-19 lab test U0001, U0002, or 87635.

Cost-sharing does not apply for COVID-19 testing-related services, which are medical visits that: are furnished between March 18, 2020 and the end of the Public Health Emergency (PHE); that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test; and are in any of the following categories of HCPCS evaluation and management codes:

  • Office and other outpatient services
  • Hospital observation services
  • Emergency department services
  • Nursing facility services
  • Domiciliary, rest home, or custodial care services
  • Home services
  • Online digital evaluation and management services

Cost-sharing does not apply to the above medical visit services for which payment is made to:

  • Hospital Outpatient Departments paid under the Outpatient Prospective Payment System
  • Physicians and other professionals under the Physician Fee Schedule
  • Critical Access Hospitals (CAHs)
  • Rural Health Clinics (RHCs)
  • Federally Qualified Health Centers (FQHCs)

For services furnished on March 18, 2020, and through the end of the PHE, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under these payment systems should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services.

For professional claims, physicians and practitioners who did not initially submit claims with the CS modifier must notify their Medicare Administrative Contractor (MAC) and request to resubmit applicable claims with dates of service on or after 3/18/2020 with the CS modifier to get 100% payment.

For institutional claims, providers, including hospitals, CAHs, RHCs, and FQHCs, who did not initially submit claims with the CS modifier must resubmit applicable claims submitted on or after 3/18/2020, with the CS modifier to visit lines to get 100% payment.

Additional CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit theCurrent Emergencies Website.


Guidance for Processing Attestations from Ambulatory Surgical Centers (ASCs) Temporarily Enrolling as Hospitals during the COVID-19 Public Health Emergency

CMS is providing needed flexibility to hospitals to ensure they have the ability to expand capacity and to treat patients during the COVID-19 public health emergency. As part of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers CMS is allowing Medicare-enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients.

Guidance


COVID-19: Expanded Use of Ambulance Origin/Destination Modifiers

During the COVID-19 Public Health Emergency, Medicare will cover a medically necessary emergency and non-emergency ground ambulance transportation from any point of origin to a destination that is equipped to treat the condition of the patient consistent with state and local Emergency Medical Services (EMS) protocols where the services will be furnished. On an interim basis, we are expanding the list of destinations that may include but are not limited to:

  • Any location that is an alternative site determined to be part of a hospital, Critical Access Hospital (CAH), or Skilled Nursing Facility (SNF)
  • Community mental health centers
  • Federally Qualified Health Centers (FQHCs)
  • Rural health clinics (RHCs)
  • Physicians’ offices
  • Urgent care facilities
  • Ambulatory Surgery Centers (ASCs)
  • Any location furnishing dialysis services outside of an End-Stage Renal Disease (ESRD) facility when an ESRD facility is not available
  • Beneficiary’s home

CMS expanded the descriptions for these origin and destination claim modifiers to account for the new covered locations:

  • Modifier D – Community mental health center, FQHC, RHC, urgent care facility, non-provider-based ASC or freestanding emergency center, location furnishing dialysis services and not affiliated with ESRD facility
  • Modifier E – Residential, domiciliary, custodial facility (other than 1819 facility) if the facility is the beneficiary’s home
  • Modifier H – Alternative care site for hospital, including CAH, provider-based ASC, or freestanding emergency center
  • Modifier N – Alternative care site for SNF
  • Modifier P – Physician’s office
  • Modifier R – Beneficiary’s home

For the complete list of ambulance origin and destination claim modifiers see Medicare Claims Processing Manual Chapter 15, Section 30 A.


Lessons from The Front Lines: COVID-19

On April 3, CMS Administrator Seema Verma, Deborah Birx, MD, White House Coronavirus Task Force, and officials from the FDA, CDC, and FEMA participated in a call on COVID-19 Flexibilities. Several physician guests on the front lines presented best practices from their COVID-19 experiences. You can listen to the conversation here.


CMS COVID-19 Update Call Today

Tuesday, April 7 from 2 to 3 pm ET

Register for Medicare Learning Network events. Registration closes at 12pm ET.
CMS update on recent actions taken to address the COVID-19 public health emergency.
Target Audience: All Medicare fee-for-service providers and interested stakeholders.

By: Ray

Carta Circular 20-019

In: Circulares, Noticias


Carta Circular 20-019
PERIODO DE EMERGENCIA COVID-19
Códigos para servicios de consulta virtual o telefónica, telemedicina y seguimiento a pacientes durante COVID-19


ANEJO
Carta Normativa 20-0331 Telemedicina-TeleSalud

By: Ray

Carta Circular 20-017 | Anejo | Política

In: Circulares, Noticias


Carta Circular 20-017

MAVYRET (GLECAPREVIR, PIBRENTASVIR), NUEVO MEDICAMENTO EN EL FORMULARIO DE MEDICAMENTOS EN CUBIERTA

Política para el manejo de los pacientes diagnosticados con Hepatitis-C crónica

Anejo 7 Final de Hepatitis C

HCV -SPECIAL REGISTRY

PSG-VITAL UNIFORM GUIDELINE – PUERTO RICO HEALTH INSURANCE ADMINISTRATION

By: Ray

First Coast Service | Webcast

In: Eventos, Noticias

WEBCAST: Expansión de los beneficios de telesalud
durante COVID-19 (A / B)

Miércoles, 1 de abril

4-5 p.m. ET
Idioma que se ofrecerá: español

Durante este webcast educativo gratuito, aprenderá sobre:

  • La declaración de emergencia y las dispensas
  • Expansiones a los beneficios de telesalud
  • Qué servicios se pueden prestar a través de telesalud
  • Qué capacidades de audio y visuales están permitidas para la telesalud
  • Cómo facturar los servicios de telesalud
  • Dónde ubicar los recursos de coronavirus
  • Sesión de preguntas y respuestas

REGÍSTRESE AHORA
para asegurarse su lugar en este importante webcast de First Coast!

First Coast Service Options, Inc., and its affiliates are not responsible for errors or omissions in the transmission of this e-mail message. Any personal comments made in this e-mail do not reflect the views of First Coast Service Options, Inc., or its affiliates. The information contained in this document may be confidential and is intended solely for the use of the individual or entity to whom it is addressed. This document may also contain material that is privileged or protected from disclosure under applicable law. If you are not the intended recipient or the individual responsible for delivery to the intended recipient, please (1) be advised that any use, dissemination, forwarding, or copying of this document IS STRICTLY PROHIBITED; and (2) notify sender immediately by telephone and destroy the document. Thank you.

By: Ray