CDC updates testing guidelines per capacity increase

The CDC has revised an Aug. 24 update on testing for the SARS-CoV-2 virus, intended to account for the significance of asymptomatic and pre-symptomatic transmission. CDC said this update “further reinforces the need to test asymptomatic persons, including close contacts of a person with documented SARS-CoV-2 infection.” Prior to Aug. 24, the agency’s stance was that those who are close contacts with anyone with a confirmed infection should be tested posthaste, while the Aug. 24 update stated that testing should be done for “people who have had close contact” with anyone with a confirmed infection. The term “close contact” was at the time defined as anyone who was within six feet of an infected individual for at least 15 minutes. This latest update recommends a test for those who have been in close contact, “such as within [six] feet of a person with documented SARS-CoV-2 infection for at least 15 minutes and do not have symptoms.” The update states further, “it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested,” and that any individuals thus exposed should self-quarantine/isolate at home, and stay separated from other members of the household. However, the agency noted that the guidance was updated “in light of additional testing capacity throughout the country.” Quest Diagnostics Corp., of Secaucus, N.J., said in a Sept. 17 statement that it began offering molecular diagnostics that can be ordered online and will be reviewed by an independent physician. The sample for the test can be obtained from nares either at home or at retail locations.

OIG cites spending on noninvasive ventilators

The U.S. Office of Inspector General (OIG) at the Department of Health and Human Services said Medicare-allowed charges for noninvasive ventilators rose from $280 million in 2016 to $424 million two years later, an increase of 52%. The underlying audit reviewed Medicare-allowed charges totaling $1.1 billion for roughly 1 million monthly rental units billed under HCPCS code E0466 over the three calendar years in question, and OIG then calculated “a non-statistical estimate of payment differences” for E0466 based on a comparison of the Medicare-allowed charges and the rates of unspecified non-Medicare payers. Assuming Medicare beneficiaries were liable for 20% of the difference, the Centers for Medicare and Medicaid Services (CMS) could have saved beneficiaries $87 million had the agency aligned Medicare payment rates with those of the non-Medicare payers. However, OIG noted that the CMS had employed statutorily mandated fee schedule payments that include an annual economic update, adding that the rates for durable medical equipment under the competitive bidding program exerted no effect on rates paid for these noninvasive ventilators. The CMS said it had considered adding noninvasive ventilators to the bidding program, but that the COVID-19 pandemic made such a move inappropriate.

CMS posts radiation oncology bundled payment rule

The U.S. Centers for Medicare and Medicaid Services has posted a final rule for the radiation oncology bundled payment model, which would provide site-neutral payment levels and would be agnostic for radiotherapy type. Participation in the five-year program, which will run Jan. 1, 2021 to Dec. 31, 2025, is mandatory for all outpatient clinical sites falling into a select set of zip codes that capture roughly three in 10 of radiotherapy sites in the U.S. The program will cover radiotherapy services for 16 cancer types and will pay half the bundled payment amount at the beginning of the 90-day episode and the balance upon completion of those 90 days. Payment amounts will be adjusted for case mix and geographic factors, although the program will also apply a discount of 4.75% for the technical component and 3.75% for the professional component. BioWorld will cover the rule in greater detail in an upcoming issue.

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