On Thursday, Oct. 13, 2022, HHS Secretary Xavier Becerra announced an extension of the COVID-19 Public Health Emergency (PHE). This extension will last another 90 days from October 13, 2022. Anytime there is a PHE declaration, it can only last for 90 days at a time but can be extended or renewed. It has already been renewed multiple times.
There are several provisions tied to the duration of the PHE that will remain in place due to the extension of the PHE, including:
- Medicare’s 75/25 blended rates for non-rural, non-CBA areas
- Medicare’s 50/50 blended rate for rural areas
- COVID-19 testing at no cost to the patient
- Waivers of certain telehealth restrictions
- Waivers related to Medicare medical policies (LCD)
Remember, the competitive bid areas (CBA) continue with the existing payment methodology, known as the single payment amount (SPA); the PHE extension does not affect payments in these areas.
Reimbursement is based on the beneficiary's permanent address on file with SSA.
The next reconsideration for renewal is in January 2023.
While the PHE has been renewed for another 90 days, it would be a suitable time for suppliers to begin preparations for the PHE to be terminated. This means running reports looking for claims that are still being submitted with the CR modifier and “COVID-19” in the claimed narrative, looking to see what the CR is still being appended. Also, be familiar with the patients living in the non-rural, non-CBA areas because these areas will be affected by the reimbursement rates changing post-PHE. We do know that HHS Secretary Becerra has stated that there will be a 60-day notice prior to the termination of the PHE. We also know CMS will provide instructions near the 60-day notice of termination that will guide suppliers on the next steps.
Here is other important information from Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement with VGM & Associates, that you DON'T want to miss!
Ronda Vlog: Update on Sleep Studies for New CPAP Patients
Live Chat with Ronda: Open Mic Live Chat Oct. 28
Ronda Podcast: A Chat With Ronda Buhrmester About Important Reimbursement Updates and Getting Paid Faster
Ronda’s next appearance: Speaking at Medtrade East in Atlanta – October 2022