News

CMS Releases Updated Rules on COVID-19 Vaccine and Therapeutics Proposed Rule On October 28, CMS finalized a fourth COVID-19 Interim Final Rule with Comment, which provides coverage and payment details for COVID-19 vaccines and therapeutics. Medicare will cover the cost of COVID-19 vaccines and their administration and will waive out-of-pocket costs for both traditional fee-for-service beneficiaries and beneficiaries enrolled in Medicare Advantage plans. Medicare will pay physicians $28.39 to administer coronavirus vaccines. For vaccines that require two doses, Medicare will pay $16.95 for the first dose and $28.39 for the second dose. These rates will be geographically adjusted. The rule also requires Medicaid, Children’s Health Insurance Program agencies, and most private health plans to administer the vaccine at no cost to patients […]

CMS Releases Updated Rules on Payer Transparency and Pricing On October 29, CMS finalized its Transparency in Coverage rule. The final rule is part of a larger effort to ensure price transparency across the healthcare sector. The Transparency in Coverage rule moves to require significant public disclosures of the prices of items and services by private health insurers. The final rule has two key components: Requires group health plans and health insurance issuers in the individual and group markets to disclose to all participants/beneficiaries/enrollees cost-sharing information for covered items and services. This requirement will be phased in, with cost-sharing information for 500 “shoppable” services to be provided starting January 1, 2023, and cost-sharing for all items and services to be provided […]

New CPT Code for Costs Related to COVID-19 and Advocacy to Urge Payers to Provide Coverage On November 7, the AMA Current Procedural Terminology (CPT) Editorial Panel announced the approval of CPT code 99072 to be used to report the additional supplies, materials, and clinical staff time over and above the practice expense(s) included in an office visit or other non-facility service(s) when performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease. To help address the significant fiscal pressures placed on physicians by the COVID-19 pandemic, the AMA and other associations, including ISASS, submitted multiple letters urging the CMS, America’s Health Insurance Plans, Blue Cross Blue Shield Association, and major commercial health plans (i.e., Anthem, […]

Study Published on Medicare Utilization and Spending During COVID-19 Crisis On October 8, 2020, the Department of Health and Human Services published a study on Medicare utilization and spending in 2020 to analyze utilization and spending trends during the COVID-19 Emergency. The study, which was conducted by the Assistant Secretary for Policy and Evaluation Office of Health Policy, reported several key findings, including: Medicare beneficiary utilization of services declined substantially beginning in mid-March 2020, bottomed out the week ending April 8, and increased through June. Payments for all fee-for-service claims declined by 39% in the week ending April 8—33% for inpatient services and 49% for physician services. By the week ending July 1, weekly payments had nearly returned to 2019 […]