IHA Daily Briefing: July 30

Thursday, July 30, 2020
HHS Releases Surprise Medical Billing Report
New COVID-19 Procedure Codes, Reimbursement
New Medicare Data on COVID-19 Disparities
State, National, Global COVID-19 Updates
U.S. District Court Temporarily Halts Public Charge Rule

HHS Releases Surprise Medical Billing Report
On Wednesday, the U.S. Dept. of Health and Human Services (HHS) released a report outlining steps to implement the Administration’s principles on surprise billing. The report, which was called for in President Trump’s June 2019 Executive Order on Price Transparency, stops short of endorsing a specific legislative proposal.

“Americans have the right to know what a healthcare service is going to cost before they receive it,” said HHS Secretary Alex Azar in a press release. “President Trump and his administration have done their part to deliver historic transparency around the prices of many procedures. Now it’s time for Congress to do what we all agree is necessary: combat surprise billing with an approach that puts patients in control and benefits all Americans.”

IHA supports Congressional action to protect patients from surprise medical bills; however, IHA strongly opposes legislative proposals that would set prices in federal law, and is working to keep such a policy out of the next COVID-19 relief package.


New COVID-19 Procedure Codes, Reimbursement
Today, the Centers for Medicare & Medicaid Services (CMS) announced new procedure codes allowing Medicare and other insurers to identify use of the therapeutics remdesivir and convalescent plasma in treating COVID-19 inpatients. The new codes are effective Aug. 1, and enable CMS to conduct real-time surveillance and obtain real-world evidence on the effectiveness of these drugs in treating and protecting patients with COVID-19.

Additionally, CMS and the Centers for Disease Control and Prevention announced today that payment is available to physicians and healthcare providers who counsel patients, at the time of COVID-19 testing, on the importance of self-isolation after testing and prior to the onset of symptoms. Reimbursable counseling services include the discussion of immediate need for isolation, the importance of informing immediate household members of the necessity of testing for COVID-19, the review of COVID-19 signs and symptoms, and services available to patients to aid in isolating at home.

Should the patient test positive for COVID-19, providers should counsel patients that they need to wear a mask at all times, and that public health authorities will contact the patient for information relevant to contact tracing. CMS will use existing evaluation and management (E/M) payment codes to reimburse providers who are eligible to bill CMS for COVID-19 counseling services, regardless of where the COVID-19 test is administered. This includes doctor’s offices, urgent care clinics, hospitals and community drive-thru or pharmacy testing sites.

See CMS’ Medicare Learning Network article SE20011 and Counseling Check List for more information and resources.


New Medicare Data on COVID-19 Disparities
On Tuesday, the Centers for Medicare & Medicaid Services (CMS) released an update on COVID-19 among Medicare beneficiaries, covering Medicare claims and encounter data from Jan. 1, 2020 through June 20, 2020. The overall Medicare hospitalization rate for COVID-19 was 254 per 100,000 during this period, with hospitalization rates remaining highest for Black Medicare beneficiaries at 670 per 100,000. This update also shows that American Indian/Alaskan Native Medicare beneficiaries experience the second highest hospitalization rate for COVID-19 at 505 per 100,000. Previously, a lack of data prevented CMS from reporting on how COVID-19 affects the American Indian/Alaskan Native Medicare population.

Dual eligibility for both the Medicare and Medicaid programs also appears to drive hospitalization. Dual eligible beneficiaries are disproportionately more likely to experience a COVID-19 hospitalization across all demographics, with Black, Hispanic and American Indian/Alaskan Native dual eligible beneficiaries disproportionately affected compared with Asian and White dual eligible beneficiaries.

The CMS Office of Minority Health recently hosted three listening sessions with stakeholders who serve and represent racial and ethnic minority Medicare beneficiaries. According to CMS, these sessions provided information on ways in which CMS can address social risks and other barriers to healthcare that will assist in current and future efforts to reduce health disparities.

Other findings include approximately equal proportions of hospitalized Medicare beneficiaries discharged to their home and passing away during their hospital stay (27% and 26%, respectively). Medicare COVID-19 fee-for-service payments total $2.8 billion as of June 20, with per beneficiary spending ranging from about $5,000 (5th percentile) to $71,000 (95th percentile). The most common chronic conditions among hospitalized fee-for-service Medicare beneficiaries include hypertension, hyperlipidemia, chronic kidney disease, diabetes and anemia.

More information on Medicare COVID-19 data is on CMS’ website, including an FAQ on this data release.


State, National, Global COVID-19 Updates
The Illinois Dept. of Public Health (IDPH) announced today 1,772 new COVID-19 cases (the highest daily number since May 24) and 18 deaths. The total number of cases in the state is 176,896 in 102 counties, with a total of 7,478 deaths. IDPH says that in the past 24 hours, 41,134 test specimens have been processed, with a positivity rate of 4.3%. The preliminary seven-day statewide positivity rate from July 23 to July 29 is 3.8%. Statewide COVID-19 hospitalizations in the past 24 hours decreased from 1,491 patients to 1,452 patients. Of that figure, 353 patients were in the ICU, with 149 patients on ventilators.

At a news conference in Peoria this morning, Governor J.B. Pritzker warned that the state is at a “danger point” and could be headed for a reversal of its reopening if the COVID-19 case numbers continue to go up.

Today’s Centers for Disease Control and Prevention (CDC) figures show more than 4.4 million confirmed and presumptive positive cases of COVID-19 in the U.S., with 150,283 deaths.

Today’s WHO Coronavirus Disease Dashboard shows more than 16.8 million COVID-19 cases globally, with more than 662,000 deaths. The Region of the Americas (includes the U.S.) continues to lead the world with nearly 9 million cases and more than 346,000 deaths.


U.S. District Court Temporarily Halts Public Charge Rule
On Wednesday, the U.S. District Court in the Southern District of New York temporarily halted enforcement of President Trump's “public charge” rule, which has been in effect since February and factors the use of certain public aid programs in determinations granting permanent legal status.

Judge George B. Daniels accepted New York Attorney General Letitia James’ request to temporarily block nationwide enforcement of the policy, which she argued was exacerbating the coronavirus pandemic. Under the rule, a “public charge” is someone who is “more likely than not” to receive public benefits for more than 12 months within a 36-month period. In January, the U.S. Supreme Court ruled the Trump administration could move forward with the policy, but permitted states to return to lower courts to seek an injunction. IHA has opposed the rule since it was proposed in 2018.