Public Health

CMS payment policies & regulatory flexibilities during COVID-19 emergency

Updated April 3, 2020

The AMA has been working constantly with the Centers for Medicare & Medicaid Services (CMS) to identify issues arising due to COVID-19 and to recommend specific actions to improve Medicare coverage of services and reduce regulatory burdens on physicians during this crisis.

Featured updates: COVID-19

Track the evolving situation with the AMA's library of the most up-to-date resources from JAMA, CDC and WHO.

Read the Latest

Below are key actions CMS has taken in response to AMA advocacy. Topics include telehealth, the Merit-based Incentive Payment System (MIPS), enrollment, elective surgery and regulatory relief. For the complete list of CMS payment and policy guidance related to COVID-19, please access the CMS website.

Medicare advanced payments

To assist with cash flow challenges during the COVID-19 pandemic, CMS has expanded its Advanced Payment Program to provide qualifying physicians an emergency upfront payment of up to three months’ Medicare payments based on historical claims information from Oct-Dec 2019. Physicians will need to repay this advance, and CMS has extended the repayment to give physicians 210 days from the date the Medicare Administrative Contractor issues the payment.  

AMA resources

  • Fact sheet explaining the Advanced Payment Program
  • FAQs answer common questions about timing, interest, and submitting a request

CMS resources

  • Fact Sheet on advanced payments during the COVID-19 pandemic

AMA releases special coding advice related to COVID-19

New guidance from the AMA provides special coding advice during the COVID-19 public health emergency. One resource outlines coding scenarios (PDF) to help health care professionals apply best coding practices.

The scenarios include telehealth services for all patients. Examples specifically related to COVID-19 testing include coding for when a patient:

  • Comes to the office for an E/M visit, and is tested for COVID-19 during the visit
  • Receives a telehealth visit re: COVID-19, and is directed to come to physician's office or physician’s group practice site for testing
  •  Receives a virtual check-in/online visit re: COVID-19 (not related to E/M visit), and is directed to come to physician's office for testing

There is also a quick-reference flowchart that outlines CPT reporting for COVID-19 testing (PDF).

Medicare expands telehealth during COVID-19 emergency

The Centers for Medicare & Medicaid Services (CMS) lifted Medicare restrictions on the use of telehealth services during the COVID-19 emergency. Key changes include:

  • Effective March 1 and throughout the national public health emergency, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19.
  • Medicare will pay physicians for audio-only telephone calls and has greatly expanded the list of covered telehealth services to include emergency department visits, for example.
  • Patients can receive telehealth services in all areas of the country and in all settings, including at their home.
  • CMS will not enforce a requirement that patients have an established relationship with the physician providing telehealth.
  • Consent for telehealth services may be obtained by staff or the practitioner at any time, required only once on an annual basis.
  • Physicians can reduce or waive cost-sharing for telehealth visits.
  • Physicians licensed in one state can provide services to Medicare beneficiaries in another state. State licensure laws still apply.
  • Physicians can provide telehealth services from their home. Physicians do not have to add their home to their Medicare enrollment file. 
  • HHS Office for Civil Rights (OCR) offers flexibility for telehealth via popular video chat applications, such as FaceTime or Skype, during the pandemic.

AMA tools and resources:

  • AMA’s telemedicine quick guide has detailed information to support physicians and practices in expediting implementation of telemedicine.
  • AMA’s coding scenarios (PDF) provide real-world examples of how to code for telehealth services.
  • AMA fact sheet goes into detail about Medicare’s payment and coverage expansion.
  • List of telehealth services (PDF) covered by Medicare and included in the CPT code set

CMS and HHS guidance:

  • CMS interim final rule and fact sheet detail new regulatory flexibility, relaxed enrollment requirements, expanded telehealth services, and revised physician supervision policies to help physicians and patients during the COVID-19 pandemic
  • HHS Office of Inspector General FAQs (PDF) clarify the Administration is allowing broad flexibility for physicians to reduce or waive Medicare beneficiary cost-sharing
  • CMS releases General Provider Telehealth and Telemedicine Tool Kit
  • CMS FAQs outline the new Medicare telehealth waiver
  • OCR guidance on telehealth communication methods during the COVID-19 nationwide public health emergency
  • OCR issued FAQs about its use of enforcement discretion related to HIPAA and telehealth

CMS extends MIPS deadline, expands automatic hardship exceptions

CMS extended MIPS data submission deadline for physicians and accountable care organizations from March 31, 2020 until April 30, 2020. MIPS eligible clinicians who do not submit any MIPS data by April 30, 2020 will qualify for an automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment in 2021.

CMS is evaluating options for providing relief around participation and data submission for the 2020 MIPS performance year.

CMS resources:

Medicare provides enrollment relief

During the national emergency due to COVID-19, CMS will:

  • Allow licensed physicians to provide services to Medicare beneficiaries outside their state of enrollment as long as the physician is licensed in another state. State licensure requirements still apply.
  • Temporarily suspend certain Medicare enrollment screening requirements, including criminal background checks and site visits.
  • Postpone all revalidation actions.
  • Expedite any pending or new enrollment applications.

CMS guidance:

  • CMS fact sheet discusses the Medicare enrollment flexibilities in place during the public health crisis

Medicare recommends postponing adult elective surgeries and non-essential procedures

CMS issued guidance on postponing non-essential adult elective surgery and medical and surgical procedures to conserve critical resources, such as ventilators and Personal Protective Equipment (PPE), and to minimize the spread of COVID-19 to patients and physicians.

CMS’ recommendations include a tiered framework to evaluate how best to provide surgical services and procedures to patients whose condition requires emergent or urgent attention, while postponing elective and non-essential procedures to conserve resources. Decisions remain the responsibility of hospitals, surgeons, and state and local officials. CMS expects to refine the recommendations over the course of this emergency.

CMS guidance:

CMS relieves regulatory burdens

CMS has also issued several regulatory burden waivers to provide additional relief, including:

  • CMS is temporarily waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency.
  • For durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) that is lost, destroyed, or otherwise unusable, Medicare contractors may waive replacement requirements such as: a face-to-face visit, obtaining new order from a physician, and new medical necessity documentation.

CMS guidance:

Medicare payment and coverage policies related to COVID-19