CMS Issues Interim Final Rule to Enforce COVID-19 Reporting Requirements

The Centers for Medicare and Medicaid Services (“CMS”) published an Interim Final Rule in the Federal Register on September 2, 2020 to supplement and strengthen the agency’s enforcement of COVID-19 reporting requirements. The final rule also modifies various aspects of Medicare reimbursement methodologies for health plans, physicians, and other providers. 

Limitation on Medicare Coverage of COVID-19 Testing Without an Order

In a prior Interim Final Rule with Comment Period, CMS expanded coverage for COVID-19 testing for Medicare beneficiaries by eliminating the need for an order from a treating physician or other practitioner.

CMS has now revised this policy, citing fraud and abuse concerns and clinical concerns that beneficiaries are receiving too many COVID-19 tests without medical attention and oversight. Consequently, beginning September 2 and continuing for the duration of the PHE, Medicare will cover only one (1) COVID-19 diagnostic test without the order of a physician or other practitioner. A single otherwise covered laboratory test each for influenza or a similar respiratory condition needed to obtain a final COVID-19 diagnosis, when performed in conjunction with a COVID-19 test, will also be covered. Medicare will cover additional COVID-19 tests only with the order of a physician or other practitioner.

Any COVID-19 test(s) that a beneficiary received prior to September 2, 2020 is disregarded for purposes of this new single COVID-19 test coverage rule.

Source: https://www.jdsupra.com/legalnews/cms-issues-interim-final-rule-to-84861