Temporary Medicare Billing of Outpatient Hospital Services in the Patient’s Home

On June 19, 2020, CMS issued additional FAQs to clarify the process for billing outpatient hospital services provided by hospital clinical staff in the patient’s home using telecommunication technology during the COVID-19 public health emergency (“PHE”).  While Section 603 of the Bipartisan Budget Act of 2015 requires that new, off-campus provider-based departments (“PBD”) that start billing after November 2, 2015 be paid under the Medicare Physician Fee Schedule (“MPFS”) rather than the Outpatient Prospective Payment System (“OPPS”), CMS temporarily expanded the extraordinary circumstances relocation exception policy during the PHE to permit on-campus and excepted off-campus PBDs to relocate (partially or fully) to new off-campus locations, including patients’ homes, and be paid at the OPPS payment rate.

Assuming that the relocation is consistent with the State’s emergency preparedness or pandemic plan, a hospital can request an exception using the following process:

  • Within 120 days after beginning to furnish and bill for services at the relocated off-campus PBD (including a patient’s home), the hospital must email the applicable CMS Regional Office with the following information:
    • The hospital’s CCN;
    • The date the hospital began to furnish services at the new location;
    • The address of the original on-campus PBD or excepted off-campus PBD (or partially relocated PBD, as applicable);
    • The new address(es) of the relocated PBD(s);
    • A brief description of the justification for the relocation, the role of the relocation in the hospital’s operations in addressing COVID-19, and why the new PBD location is appropriate for furnishing covered outpatient items and services;
    • An attestation that the relocation(s) is/are not inconsistent with the state’s emergency preparedness or pandemic plan; and
    • A point of contact (name, title, telephone, email) at the hospital for the request.

Additional considerations include:

  • Hospitals that use this temporary relocation exception should be able to demonstrate that the relocated PBD is the same as the excepted PBD, just relocated to a new location or multiple locations (g., if the excepted PBD is an oncology clinic, the relocated PBD in a patient’s home should be providing oncology services).
  • The original on-campus or excepted PBD can continue to bill under the OPPS, in addition to the relocated off-campus PBD(s).
  • Hospitals can begin providing services in the relocated off-campus PBD and bill for them using the “PO” modifier prior to submitting their exception request. Hospitals can bill for outpatient hospital services provided in these temporary expansion locations from March 1, 2020 through the end of the PHE.
  • Hospitals should encrypt the relocation request information prior to sending it to their CMS regional office by email.
  • A separate exception request must be filed for each on-campus and/or excepted off-campus PBD that is temporarily relocating, but if a single location is relocating to more than one new location, the hospital can supply a single CCN, single address of the original PBD, single justification and attestation, and single point of contact, as long as the hospital indicates that this information applies to all of the new PBD relocation requests.
  • Hospitals must submit each new PBD location address to CMS (including patients’ home addresses), along with the date care was first delivered in each location, but can send them in batches over a period of weeks or months, instead of individual requests. Hospitals should encrypt this information when sending and exclude any unnecessary personally identifiable information (g., encrypted excel file).
  • Hospitals are not required to submit an updated Form 855A in connection with the temporary relocation of PBDs during the COVID-19 PHE.
  • A hospital can relocate an on-campus and/or excepted off-campus PBD to a patient’s home without applying for the temporary relocation exception if the hospital bills for the services provided in those temporary locations using the “PN” modifier so that services are paid at the MPFS payment rate for non-excepted hospital services.
  • Hospitals should add the “CR” and “DR” modifier, as applicable, to all claims for services rendered at relocated PBDs acting as temporary expansion locations during the PHE.