Under the COVID-19 Public Health Emergency (PHE), which is set to end May 11, the Centers for Medicare & Medicaid Services (CMS) used emergency waiver and various regulatory authorities to provide flexibilities for providers. As the end of the PHE approaches, CMS has developed a cross-cutting initiative to reestablish certain health and safety standards and other financial and program requirements.
Through this initiative, the agency will evaluate CMS-issued PHE blanket waivers and flexibilities so that the health care system is prepared for operation once the PHE ends.
Among the flexibilities and waivers under the PHE, CMS issued blanket waivers of certain provisions of the physician self-referral law (also known as the “Stark Law”). At the conclusion of the COVID-19 PHE, the waivers will terminate and physicians and entities must immediately comply with all provisions of the Stark Law.
The payment amounts set for travel fees and laboratory specimen collection from a homebound or nonhospital inpatient will also end with the PHE termination. Medicare will also require all COVID-19 and related testing performed by a laboratory to be ordered by a physician or other practitioner.
Additionally, under Clinical Laboratory Improvement Act (CLIA) guidance, during the PHE, CMS exercised enforcement discretion to allow pathologists to review slides remotely without the need for a separate CLIA certificate for the remote location. CMS says in the fact sheet that it will continue to exercise this enforcement discretion once the PHE ends. CMS has also determined that it will continue to allow for expedited lab certification once the PHE ends, so a laboratory can begin testing as soon as it receives a CLIA number and pays a laboratory fee. CMS has also determined that at the end of the PHE, it will continue to allow labs within a hospital to hold a single certificate for laboratory sites within the same physical location.
“As CMS identifies barriers and opportunities for improvement, the needs of each person and community served will be considered and assessed with a health equity lens to ensure our analysis, stakeholder engagement, and policy decisions account for health equity impacts on members of underserved communities and health care professionals disproprotionately serving these communities,” CMS writes in the fact sheet.
For TELCOR customers, it will be important to process unbilled COVID-19 orders with dates of service prior to the May 11, 2023 deadline. For example, if labs are billing U0005 to collect an additional $25 when they completed a two-day turnaround of a high throughput COVID test, they will want to make sure those claims are submitted as soon as possible. If there are questions on updating rate schedules, expected reimbursement settings, and examining configurations for COVID-19 procedures, please contact RCM Customer Service (855-489-1207 or RCM.Service@telcor.com).