CMS Non-Emergent, Elective Medical Services, and Treatment Recommendations

As COVID-19 cases continue to increase, CMS understands the importance of reducing burdens on the existing health system and maintaining services while keeping patients and providers safe. CMS, along with medical societies and associations, created recommendations to postpone non-essential surgeries and other producers. Providing recommendations to limit medical services that could be deferred, such as non-emergent, elective treatment, and preventive medical services for patients of all ages.

A tier system has been created to help prioritize services and care to those who require emergent or urgent attention to save a life, manager a severe disease, or avoid further harm from an underlying condition. Although, the decision remains the responsibility of local healthcare delivery systems, including state and local health officials, and those clinicians who have direct responsibility for their patients.

Key Considerations:

  • Current & projected COVID-19 cases in the community/region
  • Ability to implement telehealth, virtual check-ins, and/or monitoring
  • Supply fo personal protective equipment available at the practice location
  • Staffing availability
  • Medical office/ambulatory service location capacity
  • Testing capability in the local community (Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19))
  • Health and age of each individual patient and their risk for severe disease
  • Urgency of the treatment

Tier 1

  • Definition
    • Low acuity treatment or service
  • Locations
    • Medical Office
    • FQHC/RHC*
    • HOPD*
    • Ambulatory care sites
  • Examples
    • Routine primary or specialty care
    • Preventive care visit/screening
    • Annual Wellness or Welcome to Medicare Initial Preventive Visit
    • Supervised exercise therapy
    • Acupuncture
  • Action

Tier 2

  • Definition
    • Intermediate acuity treatment or service
      • Not providing the service has the potential for increased morbidity or mortality
  • Locations
    • Medical office
    • FQHC/RHC
    • HOPD
    • Ambulatory care sites
  • Examples
    • Pediatric vaccinations
    • Newborn/early childhood care***
    • Follow-up visit for management of existing medical or mental/behavioral health condition
    • Evaluation of new symptoms in an established patient
    • Evaluation of non-urgent symptoms consistent with COVID-19
  • Action
    • Consider initial evaluation via telehealth; triage to appropriate sites of care as necessary
    • If no current symptoms of concern, consider follow-up with virtual check-in

Tier 3

  • Definition
    • High acuity treatment service
      • Lack of in-person treatment or service would result in patient harm
  • Locations
    • Medical office
      • FQHC/RHC
      • HOPD
      • Ambulatory care sites
      • Emergency department
  • Examples
    • Evaluation of new symptoms in a new patient
    • Evaluation of symptoms consistent with COVID-19, with warning signs including shortness of breath, altered mental status, or other indications of severe disease.
  • Action
    • We would not recommend postponing in-person evaluation; consider triage to appropriate facility/level of care as necessary

*Federally Qualified Health Care/ Rural Health Clinics

**Hospital Outpatient Department

*** If a practice can provide only limited well-child visits, healthcare providers are encouraged to prioritize newborn care and vaccination of infants and young children (through 24 months of age) when possible (see also CDC guidance for further information)

Sources: Centers for Medicare & Medicaid Services, Center for Disease Control and Prevention

 

Who is AdvantEdge Healthcare Solutions?

AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.

AdvantEdge