The
agency is covering monoclonal antibody therapies at no cost for a broad
range of providers and suppliers.
Susan Morse, Managing Editor
The Centers for Medicare
and Medicaid Services has posted updates to frequently asked questions and an infographic about
coverage and payment for monoclonal antibodies to treat COVID-19.
The FAQs include general
payment and billing guidance on lab testing, hospital services and inpatient
prospective payment system payments, including questions on different setting
types.
For instance, one FAQ
asks: If a COVID-19 diagnostic laboratory test is performed prior to a
procedure in a hospital outpatient department, ambulatory surgical center or
office, is it included as part of the procedure?
The answer is that,
currently, under the hospital outpatient prospective payment system, all
available COVID-19 clinical diagnostic laboratory tests are paid separately. If
a COVID-19 clinical diagnostic laboratory test is performed prior to a
procedure and billed separately, it is not bundled into the payment for the
procedure.
However, with regard to
the hospital setting, if the hospital is billing for specimen collection for
the COVID-19 clinical diagnostic laboratory test along with another hospital service,
the payment for the specimen collection would be packaged into that of the
procedure.
The infographic has facts
about expected Medicare payment to providers and information about how Medicare
beneficiaries can receive COVID-19 treatments with no cost-sharing during the
public health emergency.
WHY THIS MATTERS
The information is
provided by CMS to clear up any questions so that hospitals and physicians can
correctly bill Medicare for administering these infusions.
THE LARGER TREND
On November 10, CMS said
it would cover monoclonal
antibody therapies at no cost. This includes a broad range of providers and
suppliers, including freestanding and hospital-based infusion centers, home
health agencies, nursing homes, and entities that contract with nursing
homes, to administer this treatment in accordance with the Food and Drug
Administration's Emergency Use Authorization.
Currently, two monoclonal
antibody therapies have received EUA's for
treatment of COVID-19.
Twitter:
@SusanJMorse
Email the writer: susan.morse@himssmedia.com
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