As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED.

Future updates regarding COVID-19 will appear in the monthly Provider News publication.

Please note that the following information applies to Empire BlueCross BlueShield’s (“Empire”) Commercial health plans. Please review the Medicare and Medicaid specific sites noted below for details about these plans.

 

Commercial:  Provider News Home

Medicaid:  Medicaid Provider News - COVID-19

Medicare:  Medicare Advantage Provider News Archives

 

Information from Empire for Care Providers about COVID-19 (Updated February 9, 2022)

 

Empire is closely monitoring COVID-19 developments and what it means for our customers and our healthcare provider partners. Our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part.

 

To help address care providers’ questions, Empire has developed the following updates and frequently asked questions.

 

Contents:

Update Summary

Frequently Asked Questions:

• Empire’s actions
• COVID-19 testing
• COVID-19 vaccines
• Virtual, telehealth and telephonic care
• Coding, billing, and claims
• Other

 

Update Summary

 

COVID-19 testing and visits associated with COVID-19 testing

Empire is waiving cost shares for our fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits associated with the COVID-19 test, including visits to determine if testing is needed.  Empire looks for the CS modifier to identify visits and services leading to COVID-19 testing. This modifier should be used for evaluation and testing services in any place of service including a physician’s office, urgent care, ER or even drive-thru testing.  While a test sample cannot be obtained through a telehealth visit, the telehealth provider can help you get to a provider who can do so.

 

IMPORTANT:  In-network providers are reminded that they may not collect any deductible, copayment, or coinsurance for COVID-19 testing or visits to get the test.

 

Telemedicine (live video + audio via app)

For COVID-19 treatments via telemedicine visits, Empire will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021. 

 

For non-COVID-19 treatments via telemedicine including covered visits for mental health and substance use disorders, Empire will waive cost shares for in-network visits through November 9, 2020, or any longer period required by state law. This applies to fully insured employer plans, individual plans and Medicaid plans, where permissible.

 

For out-of-network providers, Empire waived cost shares for these services through June 14, 2020. This applied to use of our LiveHealth Online platform, as well as for care received from other providers delivering virtual care through internet video + audio services. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.

 

Telehealth (telephonic with video capability)

For COVID-19 treatments via telehealth visits, Empire will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021.

 

Effective March 16, 2020, Empire began waiving member cost sharing for telehealth visits (by phone with video capability) with in-network, providers acting within the scope of their license. Out of network visits are also covered if the member’s benefit plan has out of network benefits. This includes covered visits for medical services as well as mental health and substance use disorders services, where medically appropriate if all other requirements for a covered health service are met. Self-insured plan sponsors may have opted out of this program. This waiver will remain in place from March 19, 2020, through December 31, 2020, or any longer period required by state law for our insured employer plans, individual plans and Medicaid plans, where permissible and from March 19, 2020, through September 30, 2020, for our Medicare members. Phone/video delivery must be HIPAA compliant.

 

Telephonic-only care

Empire will also cover telephonic-only visits with in-network providers where medically appropriate if all other requirements for a covered health service are met. Out-of-network coverage will be provided where required and in accordance with benefit plan terms.

• This includes visits for medical services and behavioral health, for our fully insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible and medical appropriate.
• Cost shares will be waived for in-network providers only. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.
• Phone delivery must be HIPAA compliant.

 

Prescription coverage

Empire is also providing coverage for members to have an extra 30-day supply of medication on hand, and we are encouraging that when member plans allow that they switch from 30-day home delivery to 90-day home delivery. This applies to members who have Empire prescription drug coverage.

 

Frequently Asked Questions

 

Empire’s Actions

 

What is Empire doing to continue to address the COVID-19 crisis?

Empire is committed to help provide increased access to care, while eliminating certain costs and helping alleviate the added stress on individuals, families and the nation’s healthcare system.

 

These actions are intended to support the protective measures being taken across the country to help prevent further spread of COVID-19 and are central to Empire’s commitment to remove barriers for our members and support communities through this unprecedented time. 

 

Empire is committed to help our members gain timely access to care and services in a way that places the least burden on the healthcare system. Our actions should reduce barriers to seeing a physician, getting tested and maintaining adherence to medications for long-term health issues.

 

Empire is waiving:

• cost sharing for the treatment of COVID-19 from April 1, 2020, through January 31, 2021, for members of our fully-insured employer, individual, Medicare Advantage and Medicaid plans. We encourage our self-funded customers to participate, although these plans will have an opportunity to opt out.
• cost sharing for COVID-19 diagnostic tests as deemed medically necessary by a healthcare clinician who has made an assessment of a patient, including serology or antibody tests, for members of our employer-sponsored, individual, Medicare and Medicaid plans.
• cost sharing for visits and services during the visits to get the COVID-19 diagnostic test, beginning March 13, 2020, for members of our employer-sponsored, individual, Medicare and Medicaid plans. Cost share waiver extends to the end of the public health emergency.
• cost sharing for telemedicine visits, including visits for behavioral health, for our fully-insured employer, individual and where permissible, Medicaid plans from March 16, 2020, through December 31, 2020, or any longer period required by state law. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.
• cost sharing for S. Preventive Services Task Force (USPSTF) or CDC approved vaccines when they become available.

 

The cost sharing waiver includes copays, coinsurance and deductibles.

 

For additional services, members will pay any cost shares their plan requires, unless otherwise determined by state law or regulation. Members can call the number on the back of their identification card to confirm coverage. Providers should continue to verify eligibility and benefits for all members prior to rendering services.

 

Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing and acute rehabilitation facilities effective December 24, 2021, through January 17, 2022. These adjustments applied for our fully-insured employer, individual, and Medicaid plan members receiving care from in-network providers. For Medicare members, prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing and acute rehabilitation facilities effective December 24, 2021, through February 5, 2022. While prior authorization was not required, we required notification of the admission via the usual channels and clinical records on day two of admission to aid in our members’ care coordination and management. Empire reserves the right to audit patient transfers.

 

In compliance with New York’s Circular Letter No. 17, prior authorization requirements were suspended for patient transfers from acute IP hospitals to skilled nursing, inpatient rehabilitation, and home health care facilities effective December 23, 2020, through February 21, 2021. In addition, the suspension also applied to transfers between acute IP hospitals and inpatient mental health treatment following a hospital admission. Prior authorization will still be required for non-emergency air transport. These adjustments applied for our fully-insured and self-funded employer, individual, and Medicaid plan members. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt out. While prior authorization was not required, we required notification of the admission via the usual channels and clinical records on day two of admission to aid in our members’ care coordination and management. Empire reserves the right to audit patient transfers. Concurrent and retrospective reviews may be performed. Providers are encouraged to transfer to in-network providers. To locate an in-network provider, including skilled nursing and rehabilitation facilities, go to https://www.empireblue.com/find-care/.

 

How is Empire monitoring COVID-19?

Empire is monitoring COVID-19 developments and what they mean for our associates and those we serve. We are fielding questions about the outbreak from our customers, members, providers and associates. Additionally, our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part to further support our stakeholders.

 

Empire has a business continuity plan for serious communicable disease outbreaks, inclusive of pandemics. Empire’s enterprise wide business continuity program includes recovery strategies for critical processes and supporting resources, automated 24/7 situational awareness monitoring for our footprint and critical support points, and Empire’s Virtual Command Center for Emergency Management command, control and communication.

 

In addition, Empire has established a team of experts to monitor, assess and help facilitate timely mitigation and response where we have influence as appropriate for the evolving novel coronavirus crisis.

 

How can you ensure that your contracted providers can still provide services during this crisis?

Empire is committed to working with and supporting its contracted providers. Our benefits already state that if members do not have appropriate access to network physicians that we will authorize coverage for out-of-network physicians as medically necessary.

 

In addition, Empire’s telehealth provider, LiveHealth Online, is another safe and effective way for members to see a physician to receive health guidance related to COVID-19 from home via a mobile device or computer with a webcam. 

 

COVID-19 testing

 

When member cost sharing has been waived (where permissible) by Empire as outlined in this FAQ for COVID-19 testing and visits associated with COVID-19 testing, telemedicine (video + audio) services, telehealth (telephonic with video capability) and telephonic-only services, how does that impact provider reimbursement?

Empire will process the claim for in-network services as if there is no member cost sharing, as it does, for example, with preventive health services. Out-of-network coverage will be provided where required and in accordance with benefit plan terms.

 

How is Empire reimbursing participating hospitals that perform COVID-19 diagnostic testing in an emergency room or inpatient setting?

Reimbursement for COVID-19 testing performed in a participating hospital emergency room or inpatient setting is based on existing contractual rates inclusive of member cost share amounts waived by Empire. As we announced on March 6, 2020, Empire will waive cost shares for members of our fully insured employer-sponsored, individual, Medicare, Medicaid and self-funded plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test. 

 

How is Empire reimbursing participating hospitals that are performing COVID-19 diagnostic testing in a drive-thru testing setting?

Based on standard AMA and HCPCS coding guidelines, for participating hospitals with a lab fee schedule, Empire will recognize the codes 87635 and U0002, and will reimburse drive-thru COVID-19 tests according to the lab fee schedule inclusive of member cost share amounts waived by Empire.  Participating hospitals without lab fee schedules will follow the same lab testing reimbursement as defined in their facility agreement with Empire inclusive of member cost share amounts waived by Empire. As we announced on March 6, 2020, Empire will waive cost shares for members of our fully-insured employer-sponsored, individual, Medicare, Medicaid and self-funded plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test.

 

Does Empire require a prior authorization on the focused test used to diagnose COVID-19?

No, prior authorization is not required for diagnostic services related to COVID-19 testing.

 

Does Empire require use of a contracted provider for the COVID-19 lab test in order for waiver of the member’s cost share to apply?

Empire will waive member cost shares for COVID-19 lab tests performed by participating and non-participating providers. This is applicable for our employer-sponsored, individual, Medicare and Medicaid plan members. Self-insured plan sponsors are required under federal law to also waive cost sharing for COVID-19 tests and visits to get the test.

 

What codes would be appropriate for COVID-19 lab testing?

Empire is encouraging providers to bill with codes U0001, U0002, U0003, U0004, 86328, 86769 or 87635 based on the test provided.

 

COVID-19 vaccines

 

How is Empire reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines?
The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government.

 

For members of our fully-insured employer and individual plans as well as self-funded plans, Anthem will reimburse for the administration of COVID-19 FDA-approved vaccines at the established national CMS rates, unless otherwise required. Anthem will cover the administration of COVID-19 vaccines with no cost share for in- and out-of-network providers, during the national public health emergency, and providers are not permitted under the federal mandate to balance-bill members.

 

For members of Medicare Advantage plans, CMS issued guidance (https://www.cms.gov/files/document/COVID-19-toolkit-issuers-MA-plans.pdf) that the COVID-19 vaccine administration should be billed by providers to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved. This will ensure that Medicare Advantage members will not have cost sharing for the administration of the vaccine.

 

For members of Medicaid plans, Medicaid state-specific rate and other state regulations may apply.

 

What CPT/HCPCS codes would be appropriate to consider for the administration of a COVID-19 vaccines?

 

CMS has provided coding guidelines related to COVID-19 vaccines: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies  

 

Virtual telemedicine, telehealth and telephonic care

 

How will Empire cover telehealth (telephonic with video capability)? 

Effective March 16, 2020, Empire began waiving cost sharing for telehealth visits (by phone with video capability) where medically appropriate if all other requirements for a covered health service are met with in-network providers. Out of network visits are also covered if the member’s benefit plan has out of network benefits. This will remain in place through March 31, 2021, or any longer period required by state law. Self-insured plan sponsors may opt out of this program.

 

What codes would be appropriate to consider for telehealth, telemedicine or a telephonic visit?

Based on standard coding guidelines from the AMA and HCPCS, office visit (99201-99215) telehealth claims will require Place of Service (POS) code “02” or “10” and either modifier “95” or “GT”. 

 

For Medicare Advantage telehealth claims, please follow original Medicare coding guidance.

Audio-only telephonic codes (99441, 99442, 99443, 98966, 98967, 98968) do not require a telehealth modifier to be appended. Place of service would be the location where the provider initiates such a call.

For Medicare Advantage audio-only telephonic claims please use codes 99441, 99442, 99443, 98966, 98967 and 98968. Note, however, Medicare Advantage coding for either telehealth or audio-only telephonic claims could change in the future based on guidance from CMS.

 

How does a provider submit a telehealth, telemedicine or a telephonic visit with an existing patient who lives in a bordering state?

For providers (for example, in bordering states) who were previously seeing members in approved locations that met state and/or CMS billing requirements, effective from March 17, 2020, through March 31, 2021, or any longer period required by state law, you may submit your telehealth claim using the primary service address where you would have normally seen the member for the face-to-face visit.

 

Is Empire’s vendor, LiveHealth Online, prepared for the number of visits that will increase to telehealth?

As there is a heightened awareness of COVID-19 and more cases are being diagnosed in the United States, LiveHealth Online is increasing physician availability LiveHealth Online stands ready to have physicians available to see the increase in patients, while maintaining reasonable wait times.

 

How can I support access to telemedicine?

Providers can apply to join the LiveHealth Online panel of providers here: https://providers.amwell.com/.

 

What codes would be appropriate to consider for a telemedicine (video +audio) health visit with a patient who wants to receive health guidance related to COVID-19?

Submit Telemedicine with the CPT code for the service rendered, place of service (POS) code “02” or “10”, and append either modifier “95” or “GT”.

 

What codes would be appropriate to consider for telemedicine (live video + audio via app) and telehealth (telephonic with video capability) for physical, occupational, and speech therapies?

See the Allowed Virtual Services document located on anthem.com/For Providers/Provider Resources/Forms & Guides/Select a State/Allowed Virtual Services (Telehealth/Telemedicine) for allowable codes for telehealth visits for physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” or “10” and modifier “95” or “GT” would be appropriate for our fully-insured employer, individual, Medicare Advantage plans  and Medicaid plans, where permissible.

 

How does a provider submit a telemedicine visit with an existing patient that lives in a bordering state? 

For providers (for example, in bordering states) who were previously seeing members in approved locations that met state and/or CMS billing requirements, effective from March 17, 2020, through March 31, 2021, or any longer period required by state law, you may submit your telemedicine claim using the primary service address where you would have normally seen the member for the face-to-face visit.

 

What is the best way that providers can get information to Empire’s members on Empire’s alternative virtual care offerings?

Anthem.com and Empire’s COVID-19 site (https://www.empireblue.com/coronavirus/) are great resources for members with questions and are being updated regularly.

 

Empire members have access to telemedicine 24/7 through LiveHealth Online. Members can access LiveHealth Online at https://livehealthonline.com/ or download the LiveHealth Online app from the App Store or Google Play.

 

Empire members also can call the Empire 24/7 NurseLine at the number listed on their Empire ID card to speak with a registered nurse about health questions.

 

Coding, billing, and claims

 

Does Empire have recommendations for reporting, testing and specimen collection?

The Centers for Disease Control and Prevention (CDC) updates these recommendations frequently as the situation and testing capabilities evolve. See the latest information from the CDC: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html.

 

What diagnosis codes would be appropriate to consider for a patient with known or suspected COVID-19 for services where a member’s cost shares are waived?

The CDC has provided coding guidelines related to COVID-19:  https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf.

What modifier is appropriate to waive member cost sharing for COVID-19 testing and

visits related to testing?

CMS has provided the Medicare guideline to use the CS modifier: https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-10-mlnc-se. Empire also looks for the CS modifier to identify claims related to evaluation for COVID-19 testing. This modifier should be used for COVID-19 evaluation and testing services in any place of service. 

 

Does Empire expect any slowdown with claim adjudication because of COVID-19? 

We are not seeing impacts to claims payment processing at this time. 

 

Should providers who are establishing temporary locations to provide healthcare services during the COVID-19 emergency notify Empire of the new temporary address(es)?

Providers do not need to notify Empire of temporary addresses for providing healthcare services during the COVID-19 emergency. Providers should continue to submit claims specifying the services provided using the provider’s primary service address along with your current tax ID number.

 

How is Empire reimbursing pharmacists who are performing COVID-19 diagnostic testing?

Empire would expect pharmacists to bill COVID-19 diagnostic testing to the member’s medical benefits, not pharmacy benefits. This may be different from how pharmacists bill other services currently provided. Pharmacists with questions should call the “Provider Services” number on the back of the member’s insurance card. 

 

Other

 

Do these guidelines apply to members enrolled in the Blue Cross and Blue Shield Service Benefit Plan commonly referred to as the Federal Employee Program (FEP®)?

Where permissible, these guidelines apply to FEP members. For the most up-to-date information about the changes FEP is making, go to https://www.fepblue.org/coronavirus.

 

What financial assistance is available for care providers during the COVID-19 crisis?

The CARES Act provides financial relief to lessen the impact of the COVID-19 crisis. Included in the law are new resources to address the economic impact of COVID-19 on employers of all sizes. The Act expands existing federal loan programs, creates new tax credits, postpones employment tax payments, and includes additional tax relief. To help care providers navigate the resources available to them, Empire has complied information on programs we have learned about that could provide additional financial relief during this crisis. This information can be found in the Federal Resources Available for Care Providers and Employers in the Federal CARES Act article in Empire Provider News.

 

Are you aware of any limitations in coverage for treatment of an illness/virus/disease that is part of a pandemic?

Our standard health plan contracts do not have exclusions or limitations on coverage for services for the treatment of illnesses that result from a pandemic.

 

Please note that the above information applies to Empire’s Commercial health plans. Please review the Medicare and Medicaid specific sites noted below for details about these plans.

 

Commercial:  Provider News Home

Medicaid:  Medicaid Provider News - COVID-19

Medicare:  Medicare Advantage Provider News Archives

2521-0422-WP-NY

Identifying the most appropriate COVID-19 testing codes, testing sites and type of test to use can be confusing. The guidance below can make it easier for you to refer your patients to high-quality, lower-cost COVID-19 testing sites, find Empire BlueCross BlueShield (“Empire”) contracted laboratories and identify the proper CPT codes to use.

 

Contact your Empire representative if you need additional information or visit empireblue.com/coronavirus/providers.

COVID-19 testing coding guidelines

• For a new or established patient, CPT code 99211 would be appropriate if patient is being seen for no other services besides a specimen collection.
• For a patient assessment in addition to a specimen collection it is appropriate to bill the applicable E&M service, CPT codes 99202-99215. Specimen collection is a component of the E&M service and not separately reimbursable. Effective 04/01/2021, CPT codes G2023 and G2024 are appropriate when billed by clinical laboratories only and are not appropriate for provider practices.

Refer patients to empireblue.com/coronavirus to find convenient testing locations

If an Empire member requests a COVID-19 test, you may refer them to empireblue.com or the Sydney Health mobile app to find testing locations near them. Our test-site finder gives members important information about each site, including days and hours of operation, and if they offer:

• Appointments or walk-ins.
• Drive-through service.
• Rapid test results.  
• Antibody testing.
• Testing for children.

Send swab tests to Empire-contracted laboratories

When providing COVID-19 molecular testing services to our members, consider utilizing the following additional in-network, high-quality labs to assist in helping to ensure that our members are receiving high value health care.

 

In-network lab	Telephone	Website
Eurofins NTD	(888) 683-5227	https://www.ntd-eurofins.com/
Eurofins Viracor	(800) 305-5198	https://www.viracor-eurofins.com/test-menu/8300-coronavirus-covid-19-sars-cov-2-rt-pcr/
Eurofins Boston Heart	(877) 425-1252	https://bostonheartdiagnostics.com/
Fulgent	(626) 350-0537	https://www.fulgentgenetics.com/covid19
Invitae	(650) 466-7242	https://www.invitae.com/en/partners/
Gravity		https://gravitydiagnostics.com/covid-19-coronavirus-testing-partners/
Mako Medical Laboraties	(919) 351-6256	https://makomedical.com/
LAB24	(800) 641-0133	https://www.lab24inc.com/corona-virus-home-test-kit
MD Tox Lab	(866) 363-0203	https://www.ihdlab.com

Consider antigen testing when rapid test results are needed

Antigen tests can be a quicker way to detect COVID-19 than nucleic acid amplification tests (NAAT), e.g. PCR. Antigen tests offer a reasonable and lower cost alternative when screening asymptomatic or low-risk patients and may be most useful for individuals within the first five to seven days of symptoms when virus replication is at its highest.

 

Antigen tests can be used to detect current infection, are relatively easy to use, and most can provide point-of-care testing results. The Centers for Disease Control and Prevention (CDC) notes that proper interpretation of antigen test results (and confirmatory testing with NAAT when indicated) is important for accurate clinical management of patients with suspected COVID-19; more information can be found here.

 

The CDC notes that when molecular tests are unavailable or rapid turnaround time is needed, antigen tests can generally be used for diagnosis of COVID-19.

 

Antigen tests are typically less sensitive, and clinicians should interpret negative results carefully.  When symptoms are present or a high clinical suspicion exists, negative antigen tests should be confirmed with a molecular test.

 

When antigen tests are used in symptomatic patients, positive antigen tests can be interpreted as indicative of SARS-CoV-2 infection and do not usually require follow-up testing.

 
Consider using COVID-19 and flu combination testing when appropriate

According to the CDC, clinicians should consider testing for other causes of respiratory illness, including infections such as influenza, when clinically appropriate.

 

1099-0421-PN-NY

 

The New York Department of Financial Services (“DFS”) recently issued a circular letter, “Charges for Personal Protective Equipment by Participating Providers”. In support with the letter, Empire is sharing with participating providers their responsibilities and working with providers to report the findings to DFS.

 

Participating providers are contractually prohibited from charging additional fees for personal protective equipment (PPE) to Empire members as part of their in-person visits. Providers can only charge members for services covered in the policies and/or contracts. Members are not responsible for any charges received from a participating provider beyond their applicable deductible, copayment, or coinsurance, including any fees charged for PPE.

 

If participating providers charged an Empire member for PPE, they should issue a refund to members immediately and contact your Empire Network Services representative to report the following:

• Member(s) impacted
• Total refunded to member(s)
• The refund process

 

You can find the full notification from the New York Department of Financial Services (“DFS”) here: https://www.dfs.ny.gov/industry_guidance/circular_letters/cl2020_14

Empire BlueCross BlueShield hosted a provider webinar to assist Behavioral Health providers in maximizing the telehealth experience.

 

The webinar recording for How to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond is now available.

 

Webinar summary:

The psychological effects of COVID-19 reach far beyond those who have fallen ill with COVID-19 or lost a loved one to the virus. The need for behavioral health services will increase due to the fear and life-altering changes the pandemic has created. And for those who are already in treatment for behavioral health or other medical conditions, those appointments have been interrupted or even discontinued due to the pandemic. 

 

Using telehealth can be a better way to continue caring for your patients or help patients access care, while promoting social distancing.

 

During the webinar recording, you’ll hear about:

• The impact of COVID-19 on behavioral health in general and within at-risk populations
• Lessons learned from past epidemics and quarantines
• Best practices for caring for behavioral health patients virtually
• Telehealth 101 tips for providers looking to get started

 

Providers of all specialties are invited to attend this webinar, which places emphasis on leveraging telehealth for behavioral health services.

We want to express our most sincere thanks for your dedication to serving the patients in your care. Please take a moment to watch this brief thank you message from Empire BlueCross BlueShield.

 

524-0620-PN-NY

As the COVID-19 pandemic continues to spread throughout the United States, we appreciate that care providers across the country on the front line are committed to providing care to our members and communities.

 

During these challenging times, Empire BlueCross BlueShield (“Empire”) remains committed to living our values and supporting those we serve, which includes making it as easy as possible for care providers  to focus on what’s important right now, keeping the country healthy.  In addition to the proactive steps Empire has already taken to support care providers and protect our members, associates and communities against COVID-19, Empire announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis.

 

The expansion covers the waiver of cost shares for COVID-19 treatment received through December 31, 2020. Empire will reimburse health care providers at in-network rates or Medicare rates, as applicable, for Empire’s affiliated health plan fully insured, Individual, Medicaid and Medicare Advantage members. Empire encourages self-funded employer participation; however, self-insured employers will be able to opt out of participation.

 

Empire continues to closely monitor the COVID-19 developments and listen to the needs of our communities, Empire associates and all of the members and care providers we serve.  We will continue to update you as we receive new information and guidance.

 

Empire BlueCross BlueShield (“Empire”) is closely monitoring COVID-19 developments and working to create solutions that address not just the physical toll of this crisis, but also the mental health needs in the state. Effective May 2, 2020, Empire began waiving cost sharing for in-network outpatient mental health services for all New York fully-insured members, including essential workers.  This waiver will be in effect until September 28, 2020, unless further extended.

 

This action is an addition to the proactive steps Empire has taken to support care providers and protect our members, associates and communities against COVID-19 including waiving cost sharing for testing treatment, expanded access to telehealth, and streamlined administrative work to ensure hospitals and providers can deliver care to more patients quickly and effectively.

 

The coverage is compliant with New York Department of Financial Services (DFS) Insurance Regulation 62 and applies to essential workers as well as all of Empire’s fully-insured employer, and Individual plans. For more information on the regulation, visit the DFS regulation available here.

 

Starting May 2, 2020, in-network outpatient providers were advised that they may not collect any deductible1, copayment, or coinsurance on outpatient mental health services for New York fully insured members. This is applies through September 28, 2020, unless further extended.

 

¹ Waiver of cost sharing does not apply to deductibles for high deductible health plans.

Webinar recording now available for network providers on SBA loans and other federal relief programs in response to COVID-19

 

We are committed to helping care providers learn how you can secure resources to support yourselves and your business during the COVID-19 crisis. Empire BlueCross BlueShield (“Empire”) hosted a provider webinar to share information and resources with its network providers regarding opportunities providers have to access loans through the U.S Small Business Administration (SBA) and other federal programs in response to the economic impact of COVID-19 on care providers that are also small employers.

 

The Small Business Loan Opportunities for Providers webinar recording is now available.

 

After registering, use the password “health” to access the webinar.

 

Webinar summary:

The federal Coronavirus, Aid, Relief and Economic Security (CARES) Act included an initial $350 billion Paycheck Protection Program (PPP) that provides 100% federally guaranteed loans to small employers. These loans may be forgiven if borrowers maintain or restore their payrolls to pre-COVID-19 levels. On Monday, April 27, 2020, the SBA resumed accepting applications for PPP loans in response to an additional $320 billion added to the program. This webinar recording shares information about federal financial relief for providers in response to the COVID-19 crisis. Use the password “health” to access the webinar.

 

The information and resources provided here and during webinar recordings is educational and informational only, which providers can use to learn about resources and opportunities that may be available, and do not constitute and should not be considered legal advice. Empire cannot be held responsible for any errors or omissions.

During the COVID-19 crisis, care providers are working to keep the country running while navigating the financial impact it is having on them. Empire BlueCross BlueShield (“Empire”) advocated for Congress to provide sufficient funding for hospitals to be able to address those in need of care and we strongly support federal and state efforts to address the financial needs of care providers. To help care providers navigate the resources available to them Empire has compiled information on programs we have learned about that could provide additional financial relief during this crisis.

 

The Coronavirus Aid, Relief, and Economic Security (CARES) Act is the third in a series of COVID-19 federal laws designed to assist in addressing COVID-19 and provide financial relief to lessen the impact. The CARES Act includes new resources to address the economic impact of COVID-19 on employers of all sizes, including care providers. The CARES Act provides significant funding specifically for care providers AND expands existing federal loan programs, creates new tax credits, postpones employment tax payments, and includes additional tax relief for employers, including care providers.

 

Funding specifically designated for care providers in the CARES Act includes:

 

• $100 billion grant program for the U.S. Department of Health and Human Services (HHS) to provide direct assistance to hospitals and other eligible Medicare providers and suppliers to cover unreimbursed healthcare-related expenses or lost revenues attributable to the COVID-19 public health emergency;

 

• Advance Medicare payments for care providers and suppliers through Accelerated and Advance Payment Program allowing hospitals to receive 100% of three months of advanced payments through Medicare. Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100% of the Medicare payment amount for a six-month period.  Critical Access Hospitals can request up to 125% of Medicare payment for six months;
• 20% increase in reimbursement to hospitals in the Medicare program for inpatient stays coded as COVID-19, applicable during the emergency period.
• Suspension of the Medicare “sequester cuts” under current law that would have reduced payments to hospitals and providers by 2 percent. This suspension lasts from May 2020 through December 2020 increasing Medicare payments to hospitals and providers by 2 percent.
• Elimination of $8 billion in Medicaid Disproportionate Share Hospital cuts which were scheduled to go into effect on May 23, 2020.

 

Loans and Tax Relief for Employers, including Care Providers

 

Paycheck Protection Program (PPP) for Small Employers

 

This program provides employers, 501(c)(3) nonprofits, veterans organizations and tribal small businesses that generally have fewer than 500 employees with loans of up to $10 million through the U.S. Small Business Administration 7(a) loan program. Both the U.S. Small Business Administration (SBA) and the U.S. Treasury Department have issued guidance on these loans, which can serve as great resources for small employers.

 

Lenders may begin processing PPP loan applications as soon as April 3, 2020, and the program will be available through June 30, 2020. Please note that these loans will be fully forgiven if employees are kept on payroll for eight weeks and the funds are used for payroll costs including health benefits, interest on mortgages, rent, and utilities. Additional details on the PPP program include:

 

• You can apply through any existing SBA 7(a) lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System institution that is participating. Other regulated lenders will be available to make these loans once they are approved and enrolled in the program. You should consult with your local lender as to whether it is participating in the program.
• PPP Loan payments will also be deferred for six months. No collateral or personal guarantees are required.
• Neither the government nor lenders will charge small businesses any fees.
• The business must have been in operation on February 15, 2020.
• Eligible entities also include sole proprietors, independent contractors, and other self-employed individuals.
• PPP Loan amounts are 250% of the average total monthly payroll costs incurred during the one-year period before the date of the loan.
• Allowable uses of the PPP loan include ongoing payroll support (including health care benefits/insurance premiums), as well as mortgage interest, rent, and utility payments.
• All businesses are eligible irrespective of ability to pay, and if the employer maintains employment levels, it is eligible for loan forgiveness equal to the amount spent by the borrower during an 8-week period after the origination date of the PPP loan on payroll costs, mortgage interest, rent/lease, and utilities.
• Mandates all participating lenders to defer payments for at least six months (up to one year).

 

Economic Injury Disaster Loan (EIDL) & Emergency Economic Injury Grants

 

• EIDLs allow small businesses to receive immediate cash advance payments of $10,000 in three days and waiver of certain requirements on loans of less than $200,000. To access the advance, the business first applies for an EIDL and then requests the advance. The advance does not need to be repaid under any circumstance and may be used for payroll, to pay for sick leave, or pay business obligations such as rent/mortgage and debt.
• EIDLs are lower interest loans with principal and interest deferment at the SBA Administrator’s discretion.
• Eligible entities are businesses, cooperatives, employee stock ownership plans, and tribal small business concerns with fewer than 500 employees, or any individual operating as a sole proprietor or an independent contractor. Private nonprofit businesses of any size are also eligible.
• An EIDL may be used for payroll and other operating expenses, but cannot be used for the same purposes as a PPP Loan.
• Eligible entities can get both an EIDL and a PPP loan, but any advance amount is subtracted from the amount forgiven in the PPP loan.

 

Small Business Association (SBA) Express Bridge Loans

 

• Express Bridge Loan Pilot Programallows small businesses who currently have a business relationship with an SBA Express Lender to access up to $25,000 quickly.
• These loans can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing and can be a term loans or used to bridge the gap while applying for a direct SBA Economic Injury Disaster Loan (EIDL).
• If a small business has an urgent need for cash while waiting for decision and disbursement on an EIDL, they may qualify for an SBA Express Bridge Loan.
• Loan will be repaid in full or in part by proceeds from the EIDL

 

Small Business Debt Relief

 

• Eligible small businesses are those with non-disaster Small Business Administration (SBA) loans (loans not made under the Paycheck Protection Program) and others
• The SBA will cover all loan payments on these SBA loans for 6 months.
• This relief is also available to new borrowers who take out eligible loans within 6 months of March 27, 2020.

 

Financial Support for Medium and Large Employers

 

The CARES Act includes $454 billion for the U.S. Treasury Department to be used to capitalize one or more loan facilities, established by the Federal Reserve, to make direct secured business loans to companies, including those with between 500 and 10,000 employees. These loans would be fully secured by the borrower’s assets and that the borrower not engage in stock buybacks or furnish dividends while the loan is outstanding and for 12 months thereafter, and agree to limits on executive compensation. Once additional details and guidance are released, this information will be updated.

 

Employee Retention Tax Credits for all Businesses

 

Any employer or 501(c)(3) tax-exempt organization experiencing more than a 50 percent drop in gross receipts during the COVID-19 crisis is eligible for an advanceable or refundable payroll tax credit for keeping employees on the payroll.  The amount of credit each quarter is up to 50 percent of wages (up to $10,000) (Sec. 2301). The IRS recently released guidance on this tax credit.

 

• Eligible employers are those subject to a full or partial shut-down order due to the COVID-19 pandemic, or those employers who see gross receipts decline by more than 50% when compared to the same quarter in 2019.
• Wages of employees who are furloughed or face reduced hours as a result of their employers' closure or economic hardship are eligible for the credit.
• For employers with 100 or fewer full-time employees, all employee wages are eligible, regardless of whether an employee is furloughed.
• Employers receiving a Paycheck Protection Program loan through the SBA are not eligible.

 

Postponement of Payroll Tax Payments

 

Employers and self-employed individuals can defer paying their share of applicable 2020 payroll taxes to free up cash to fund operations and support retaining employees. 

 

• This is not available to small employers who have had debt forgiven through the Paycheck Protection Program.
• Employer may defer 100% of the 6.2% employer-share of the old age, survivors and disability insurance (OASDI) portion of the Federal Insurance Contribution Act (FICA) taxes due on wages paid after March 27, 2020 through the end of 2020.
• Self-employed individuals may also delay the payment of 50% of the OASDI
• Half of the tax that would have been paid in 2020 can be paid at the end of 2021, and the other half at the end of 2022.

 

Carryback of Net Operating Losses

 

• Allows businesses to carry back for five years 100% of losses for tax years 2018, 2019 and 2020.
• This will allow businesses to offset taxable income and access cash to support business operations in 2020 and future years.

 

Increased Deduction for Interest Expense

 

• For 2019 and 2020 increases the amount of interest expense that businesses (corporations and partners in partnership) are allowed to deduct, by increasing the limitation from 30% of adjusted taxable income to 50%.
• This provision allows businesses to increase liquidity with a reduced cost of capital.

 

Accelerated Depreciation of Qualified Improvement Property

 

• This provision classifies qualified improvement property as 15-year life, which also allows such property to be eligible for bonus depreciation.

Please be advised that the New York State Department of Financial Services (DFS), the New York State Department of Health, and the federal government are directing payers to waive patient copayments, coinsurance, and deductibles for certain testing and treatment due to the COVID-19 emergency.

 

1. Commercial Health Insurance, Medicaid, Medicaid Managed Care, Child Health Plus, and the Essential Plan

 

The New York State Department of Financial Services (DFS) and the New York State Department of Health (DOH) have waived patient copayments, coinsurance, and deductibles for in-network laboratory tests, in-network provider visits, and visits at the emergency department of a hospital to diagnose COVID-19 effective March 13, 2020 for 90 days during the state of emergency.  In addition, the Departments have also waived patient copayments, coinsurance, and deductibles for all covered telehealth services effective March 16, 2020 for 90 days during the state of emergency.  The waivers apply to commercial health insurance coverage, Medicaid, Medicaid Managed Care, Child Health Plus, and the Essential Plan.  Providers should not collect the copayment, coinsurance, or deductible from the patient, and, to the extent possible, notify the health plan that they have waived cost sharing.  Instead, the health plan will reimburse the provider directly.  For more information see the following resources.

 

• DFS regulation to waive cost-sharing for laboratory tests and visits to diagnose COVID-19.
• DFS regulation to waive cost-sharing for telehealth.
• DFS Circular Letter on telehealth coverage.
• DFS Q&A on telehealth coverage.
• DOH Comprehensive Telehealth guidance for Medicaid providers.
• New York State Office of Mental Health guidance.
• New York State Office of Addiction Services and Supports:
  • o Letter to providers March 9, 2020 – waives and modifies certain tele-practice regulations.
  • o Letter to providers March 17, 2020 – regarding provider attestation.
  • o Teleconference waiver update I (issued March 13, 2020).
  • o Teleconference waiver update II (issued March 18, 2020).

 

 

2. Self-Funded Plans

 

The federal government has waived prior authorization and copayments, coinsurance, and deductibles for a diagnostic test and items and services furnished during a visit that results in administration of diagnostic test for COVID-19 for individual and group fully-insured and self-funded plans.

3. Medicare

 

The federal government has passed legislation providing that during the emergency period, Medicare will pay the entire cost, and no deductible will be applied, for any medical visit that results in an order for, or the administration of, a test for COVID-19 or that relates to an evaluation to determine whether such test is needed.

 

Empire BlueCross BlueShield (“Empire”) is closely monitoring COVID-19 developments and what it means for our customers and our healthcare provider partners. With more than 37,000 people testing positive for COVID-19 in New York, demand for inpatient hospital services will increase greatly. As a result, the New York Department of Financial Services (DFS) has issued a circular letter dated March 20, asking all insurers to suspend certain utilization management review and notification requirements to free up staff for clinical support.  Effective March 20, Empire has implemented the following for Individual, employer-based fully-insured and self-insured (ASO)*, Medicare** and Medicaid plans:

 

Suspension of Preauthorization Requirements for Scheduled Surgeries or Admissions at Hospitals 

Empire is committed to working with and supporting hospitals. As of March 20, Empire is removing prior authorization requirements for scheduled surgeries or admissions at hospitals for the next 90 days to allow hospitals to utilize needed staff in clinical roles. Hospitals should continue admission notification to Empire in an effort to verify eligibility and benefits for all members prior to rendering services and to assist with ensuring timely payments. Empire may review any applicable cases retrospectively upon the resumption of retrospective review.

 

Suspension of Concurrent Review for Inpatient Hospital Services 

Empire is suspending concurrent review requirements for 90 days effective March 20. Hospitals should continue admission notification to Empire in an effort to verify eligibility and benefits for all members prior to rendering services and to assist with ensuring timely payments. This will reduce the amount of communication with Empire to allow hospitals to focus on patient care. Empire shall review any applicable cases retrospectively upon the resumption of retrospective review.

 

Suspension of Retrospective Review for Inpatient Hospital Services and Emergency Services at In-Network Hospitals and Payment of Claims

Empire is suspending retrospective reviews for inpatient hospital services and emergency services provided at in-network hospitals for 90 days. The effect of this change is these claims will be paid without being reviewed for medical necessity for 90 days effective March 20. The Circular Letter explains that hospitals should not enforce any contractual limitations regarding the permissibility of retrospective review or overpayment recovery.

 

Hospital Discharge Planning and Preauthorization for Home Health Care and Inpatient Rehabilitation Services Following an Inpatient Hospital Stay

In an effort to allow hospitals to increase inpatient capacity by quickly discharging patients to subacute or home settings, Empire is suspending for 90 days preauthorization requirements for home health care services and inpatient rehabilitation stays (including inpatient rehabilitation services for mental health or substance use disorder treatment) following an inpatient hospital admission. Home health care services may be reviewed concurrently and retrospectively. This applies to concurrent and retrospective reviews for home health care services. This will allow members to be discharged more quickly and into services that will aid in their recovery from inpatient services. Hospitals must make every effort to transfer patients to in-network rehabilitation facilities. Empire shall review any applicable cases retrospectively upon the resumption of retrospective review.

 

Notification Requirements for Emergency Hospital Admissions 

Empire is suspending requests for medical records as part of the notification for emergency hospital admissions for 90. Hospitals should continue admission notification to Empire in an effort to verify eligibility and benefits for all members prior to rendering services and to assist with ensuring timely payments.

 

Issuer Audits of Hospital Payments and Overpayment Recovery

Empire is suspending for 90 days non-essential audits of hospital payments. This will allow hospitals to focus on patient care during this crisis. The Circular letter indicates that Hospitals should toll contractual time limits on audits and overpayment recoveries while these audits are suspended.

 

* Because ASO plans are not insured, these customers have the option to opt out of the following provisions if they so choose.

 

** For Medicare plans, please note:

• A shorter timeframe or changes in action may be necessary where required by federal law.
• Medicare reserves the right to perform post-payment reviews for all services.
• Medicare Appeals timeframes are dictated by CMS.
• Audits/Recovery: Medicare is exempt from that statement.

For updated information on COVID-19, please continue to check Provider News & Announcements at Medicaid Provider News - COVID-19 for the latest Medicaid information, and Important Medicare Advantage Updates at empireblue.com/medicareprovider for the latest Medicare information.