COVID-19’s Impact on Payor Regulations

Thoughtware Alert Apr 08, 2020
Stethoscope and laptop

In response to the Trump administration’s March 13 declaration of a national emergency due to the SARS-CoV-2 virus and incidence of COVID-19, CMS enacted temporary regulatory waivers and new rules to relieve the administrative burden during the ongoing crisis. New rules have been implemented across the U.S. to assist healthcare facilities with increased flexibility. New temporary rules regarding the use of telehealth, skilled nursing waivers and paperwork reduction have been highlighted in previous BKD Thoughtware® articles.

In addition to changes affecting Medicare beneficiaries, CMS and some insurance commissioners have advised insurance companies to follow CMS’ lead and reduce administrative burden for their healthcare policies. Consequently, insurance companies have begun implementing similar temporary changes for their health plan members and in-network providers.

BKD’s Health Care Performance Advisory Services team has developed a quick reference guide to summarize key temporary policy changes for some of the top commercial payors, including:

  • Aetna
  • Blue Cross Blue Shield
  • Cigna
  • Humana
  • UnitedHealthcare 

The top categories for regulatory changes include:

  • Changes in authorization requirements, including prior authorization and post-acute care
  • Changes in COVID-19 testing requirements and procedures, including ICD-10 and HCPCs codes, cost sharing and coverage
  • Changes in pharmacy regulations, including early prescription refills
  • Changes in telehealth regulations, including service expansions and coding and billing

Additional regulatory changes, including state-specific plan regulations, are listed on the payors’ websites and linked in the reference guide. As with most topics related to COVID-19, changes are being made rapidly. Please note that this information is current as of the publication date. BKD will attempt to update the reference guide regularly.

For more information on this developing situation, reach out to your BKD Trusted Advisor™ or use the Contact Us form below.

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