Costs for testing are being waived as diagnostic tests proceed.
EDITOR’S NOTE: The World Health Organization (WHO) has declared that the coronavirus is now a pandemic.
With the novel coronavirus (COVID-19) outbreak intensifying across the country and large-scale public gatherings of all types being postponed or canceled en masse, federal officials and insurers are scrambling to eliminate financial barriers to testing and care, marking part of a broader effort to ensure that the nation’s healthcare infrastructure does not become overwhelmed.
The Centers for Medicare & Medicaid Services (CMS) announced Tuesday that many leading insurance companies and their industry associations are now indicating that they will be treating COVID-19 diagnostic tests as covered benefits, and will be waiving cost-sharing that would otherwise. The agency also pledged to provide more flexibility to Medicare Advantage and Part D plans, “to ensure they have the tools they need to provide seniors with the best coverage.”
As part of a flurry of related activity, CMS published a memorandum to Medicare Advantage (MA) and Part D health and prescription drug plans, informing them of the flexibilities they have to provide healthcare coverage to Medicare beneficiaries for COVID-19 testing, treatments, and prevention.
More than 1,000 people have now tested positive for the virus in more than 30 states, with pockets of infection reflecting substantial ease of spread.
“The President directed CMS to make sure Medicare Advantage beneficiaries have access to the healthcare services they need during this time,” CMS Administrator Seema Verma said in a statement. “Today we announced guidance to Medicare Advantage and Part D plans to remove barriers that could prevent or delay beneficiaries from receiving care. Medicare beneficiaries are at the greatest risk of serious illness due to COVID-19, and CMS will continue doing everything in our power to protect them.”
In the aforementioned memorandum, CMS outlined the flexibilities MA and Part D plans have to waive certain requirements to help prevent the spread of the virus; specifically, the relief involves:
The changes mark part of a broader effort on the part of the newly created White House Coronavirus Task Force, which has publicly announced an intention to ensure that all Americans – particularly those at high risk of complications from the COVID-19 virus – have access to benefits while helping to contain the spread of disease.
To view CMS’s memorandum for MA and Part D plans, go online to https://www.cms.gov/files/document/hpms-memo-covid-information-plans.pdf.
CMS has announced changes in policy to address the coronavirus outbreak several times per week recently, including half a dozen times since the start of the month alone:
On March 9, CMS delivered guidance on the screening, treatment, and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of COVID-19 in a hospice setting. CMS also issued additional guidance specific to nursing homes to help control and prevent the spread of the virus: https://www.cms.gov/newsroom/press-releases/cms-issues-clear-actionable-guidance-providers-about-covid-19-virus
Also on March 9, CMS issued a press release highlighting the telehealth benefits in the agency’s Medicare program for use by patients and providers: https://www.cms.gov/newsroom/press-releases/telehealth-benefits-medicare-are-lifeline-patients-during-coronavirus-outbreak
Additionally, on March 9, CMS published guidance to hospitals with emergency departments (EDs) on patient screening, treatment, and transfer requirements to prevent the spread of infectious disease and illness, including COVID-19, ordering that Medicare-participating hospitals follow both Centers for Disease Control and Prevention (CDC) guidance for infection control and Emergency Medical Treatment and Labor Act (EMTALA) requirements: https://www.cms.gov/newsroom/press-releases/cms-issues-call-action-hospital-emergency-departments-screen-patients-coronavirus
On March 6, CMS issued frequently asked questions and answers (FAQs) for healthcare providers regarding Medicare payment for laboratory test and other services related to the outbreak: https://www.cms.gov/newsroom/press-releases/covid-19-response-news-alert-cms-issues-frequently-asked-questions-assist-medicare-providers
On March 5, CMS issued a second Healthcare Common Procedure Coding System (HCPCS) code for certain COVID-19 laboratory tests, in addition to three fact sheets about coverage and benefits for medical services related to COVID-19 for CMS programs: https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests
On March 4, CMS issued a call to action to healthcare providers nationwide and offered important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare: https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus
This past week, the Centers for Medicare & Medicaid Services (CMS) announced the suspension of eight improvement activities under the Merit-Based Incentive Payment System (MIPS)
Clinical documentation integrity (CDI) has matured beyond its initial focus on coding accuracy and Diagnosis-Related Group (DRG) optimization. In 2025, it is central to payer
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Stay ahead of Medicare Advantage’s 2025-2026 regulatory changes in this critical webcast featuring expert Tiffany Ferguson, LMSW, CMAC, ACM. Learn how new CMS rules limit MA plan denials, protect hospitals from retroactive claim reopenings, and modify Two-Midnight Rule enforcement—plus key insights on omitted SDoH mandates and heightened readmission scrutiny. Discover actionable strategies to safeguard revenue, ensure compliance, and adapt to evolving health equity priorities before the June 2025 deadline. Essential for hospitals, revenue cycle teams, and compliance professionals navigating MA’s shifting landscape.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
