Updated on: April 16, 2020

CMS Announces Reimbursement Surge for Rapid-Result COVID-19 Testing

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Original story posted on: April 15, 2020

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The Chicago-area producers of the coveted new testing kits plan to generate 20 million units per month by June.

EDITOR’S NOTE: During recent weeks, the Centers for Medicare & Medicaid Services (CMS) has been announcing revisions to its regulatory requirements on a near-daily basis, in an attempt to ease administrative and logistical burdens on providers amid the ongoing COVID-19 pandemic. As such, articles published on one day may later be found to contain outdated information just several days later. RACmonitor.com and ICD10monitor.com are committed to providing comprehensive coverage of these changes as they continue to be made, so please stay tuned as new developments unfold. 

Medicare intends to nearly double its per-unit payment for newly developed rapid-result COVID-19 lab tests, which reduce the time required to produce results from days down to minutes, federal officials announced Wednesday.

The Centers for Medicare & Medicaid Services (CMS) said in a press release that the increase is specifically targeted to help senior populations fight the viral pandemic.

“CMS has made a critical move to ensure adequate reimbursement for advanced technology that can process a large volume of COVID-19 tests rapidly and accurately,” CMS Administrator Seema Verma said in a statement. “This is an absolute game-changer for nursing homes, where risk of coronavirus infection is high among our most vulnerable.”

Medicare will pay the higher payment of $100 each, up from $51 each, for COVID-19 clinical diagnostic lab tests “making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results, and more effective means of combating the spread of the virus,” a press release issued by CMS read. Although the announcement did not cite the manufacturing company by name, it was widely reported to be the Chicago-area Abbott Laboratories, whose m2000 machines produce results in as little as five minutes – drawing a stark contrast with wait times dragging on up to a week and longer in some of the nation’s hardest-hit areas.

The m2000 lab tests can process more than 200 specimens per day, using “highly sophisticated equipment that requires specially trained technicians and more time-intensive processes to assure quality,” CMS noted. The increased Medicare reimbursement rate will be effective starting this past Tuesday and extend for the duration of the COVID-19 national emergency. 

“For other COVID-19 laboratory tests, local Medicare Administrative Contractors (MACs) remain responsible for developing the payment amount in their respective jurisdictions,” CMS added in its press release. “As with other laboratory tests, there is generally no beneficiary cost-sharing under original Medicare.”

Bloomberg reported Wednesday that the third version of Abbott Laboratories’ m2000 can identify antibodies produced as a COVID-19 patient recovers, representing a boon for a national health system that has struggled to rebound from a slow and problematic initial testing rollout. The news outlet said that patients ultimately will be able to get the new rapid tests during a doctor’s visit, noting that Abbott has said it plans to distribute 4 million of the tests by the end of April and intends to crank out as many as 20 million per month by June.

CMS announced late last month that hospitals, laboratories, and other entities can perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital.

“This will both increase access to testing and reduce risks of exposure,” CMS said in its press release. “Additionally, CMS took action to allow healthcare systems, hospitals, and communities to set up testing sites to identify COVID-19-positive patients in a safe environment.”

The number of global COVID-19 cases soared past 2 million this week, with deaths topping 133,000. The U.S. has been the single hardest-hit nation worldwide, registering nearly 620,000 cases and nearly 28,000 deaths.

For more information on this payment announcement, go online to: https://www.cms.gov/files/document/cms-2020-01-r.pdf

Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade. He can be reached at mcspivey@hotmail.com.

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