CMS Open Enrollment for COVID-19

While the beneficiaries of CMS (Centers for Medicare and Medicaid Services) are highly at risk of Covid-19 and its devastating effects, the agency is now relaxing its rules to cover its clients. While a large majority of its clients are more than 65 years of age and are at high risk for coronavirus infection, CMS is expanding its services and flexing its rules to cover its clients who may need help if they get infected and get seriously ill. One of the most important steps it has taken is to provide temporary billing benefits during the Covid-19 crisis so that Medicare patients can start receiving treatment almost immediately.

Centers for Medicare and Medicaid Services or CMS is a US agency in the Department of Health and Human Services (HHS) that is responsible for administering major healthcare programs of the country. The body oversees Medicaid, Medicare, and CHIP, along with insurance programs of federal and state health bodies. By collecting and analyzing data and making reports, the body makes sure that there is no abuse and fraud in the healthcare system of the country. In the wake of the present-day Covid-19 pandemic, CMS has made its enrollment rules a little flexible and accelerated its enrollment process. With immediate effect, each MAC (Medicare Administrator Contractor) of the CMS is given a call center. Physician practices can call this call center to access temporary billing services for not only physicians but administrative practitioners as well.

Objective

The objective behind this step is to accelerate the rejection or approval process of temporary billing services. As soon as the MAC call center receives a call, they have to screen the practitioner over the phone itself and notify them whether their privileges are approved or rejected almost immediately during the same phone call.

There are certain key details that the providers and administrators will have to provide to gain immediate clearance from the MAC. Such details include the legal name, social security number, NPI (National Provider Identifier), physical address, contact details and phone number, valid license in or out of state, etc. If the physician or practitioner is not able to provide the needed details, the process will be delayed and they stand more chances of not meeting the screening requirements. Such callers may not be granted the temporary billing advantages and may be refused services for Medicare beneficiaries.

With an aim to expedite the screening process, the agency is relinquishing the need for site visits, revalidation and criminal background checks on its physician and non-physician practitioners. For other suppliers and service providers, including suppliers of medical equipment, CMS has waived application fees and has announced to accept online applications and process them within a week.

Authority

CMS has been authorized under section 1135 of the Social Security Act, according to which it can make flexible rules for the providers with an aim to handle the Covid-19 crisis situation. Once the physician and non-physician practitioners make their application, they will receive an email from the MAC regarding whether their application for temporary billing privileges has been approved or rejected, in addition to getting a confirmation over the phone. This means the providers can get Medicare billing approval on the same day of making the first contact, provided that they meet the enrollment guidelines and provide the necessary details.

Approach Process

Apart from making these announcements, CMS has also issued guidelines on how practitioners can approach their enrolling to furnish their telehealth services. For instance, if a practitioner is offering telehealth services from their home instead of the office, they can still apply for temporary billing services, but they will need to change their billing address with the concerned MAC. They can reach out to their MAC through the call center only and add their new address to their enrollment file. The changes will be made immediately so that the service delivery of the practitioners will not get disrupted.

In addition to these services, CMS will also increase payments for tele-visits made between physicians and Medicare beneficiaries, while keeping at par with clinic visits and outpatient visits. This will allow physicians to guide their patients on the phone, especially the elderly ones, who need help for their chronic conditions but do not have high-speed internet or AV technology. CMS has also inflated the types of practitioners who can deliver their services through phone, including occupational therapists, speech-language pathologists, and physical therapists.

One thing to remember is that all these temporary billing privileges are relevant during the Covid-19 crisis period only, and will be lifted once the national emergency subsides. After that, providers will be required to apply through the standard CMS-855 enrollment process only.

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