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Medicare Claims and MIPS Reporting During COVID-19

April 15, 2020

Medicare Claims and MIPS Reporting During COVID-19
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CS Modifier Needed on Medicare Claims Resulting in Covid-19

  • Cost-sharing does not apply for COVID-19 testing-related services, between March 18, 2020 and the end of the Public Health Emergency.
  • Testing related services are defined as:
    • Services that result in the ordering, administering or evaluation of an individual for purposes of administering a COVID test, AND
    • Any of the following E&M codes:
      • Office and other outpatient services
      • Hospital observation services
      • Emergency department services
      • Nursing facility services
      • Domiciliary, rest home or custodial care services
      • Home services
      • Online digital evaluation and management services
  • Providers should use the CS modifier on applicable claim lines (including on Telehealth/Telemedicine claims) to identify the service and to get 100% of the Medicare-approved amount.
  • For professional claims, physicians and practitioners who did not initially submit claims with the CS modifier  can correct their claims with their MAC (Novitas Solutions for LA, AR, MS). (LAMMICO will provide more information as it becomes available.)
  • For institutional claims, providers, including hospitals, CAHs, RHCs, and FQHCs, who did not initially submit claims with the CS modifier must resubmit applicable claims submitted on or after 3/18/2020, with the CS modifier to visit lines to get 100% payment.

MIPS Reporting Deadline for 2019 Extended to April 30, 2020

  • MIPS eligible clinicians who do not submit their MIPS data by this deadline will have the automatic Extreme and Uncontrollable Policy applied and receive a neutral payment adjustment for the 2021 payment year.
  • If you have already submitted data to CMS and do not want it to be scored (e.g. claims or you haven’t earned at least 30 points), you MUST apply for an Extreme and Uncontrollable Hardship. The application must be submitted before April 30.

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