Reopening America Phase II: CMS Issues Guidelines on Provision of Non-emergent Non-COVID-19 Healthcare

by | Published on Jun 11, 2020 | Medical Billing

CMS Guidelines
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While emergency medical procedures continued to be provided during the COVID-19 pandemic, non-emergency, in-patient procedures had been put on hold with the aim to keep patients and providers safe and to ensure capacity to care for COVID-19 patients. As discussed in our medical billing company’s report, CMS’s Phase I recommendations related to resuming in-person care safely in areas with low incidence or relatively low and stable incidence of COVID-19 cases. As COVID-19 cases decline and healthcare facilities across the U.S. enter Phase II of re-opening, the Centers for Medicare & Medicaid Services (CMS) issued updated guidance on June 8 regarding the provision of non-emergent non-COVID-19 healthcare (NCC). CMS has also issued guidance for patients as they consider in-person non-emergency treatment.

Guidelines for Healthcare Providers

Non-urgent or “elective” medical care comprise a wide array of services, ranging from office visits to office-based procedures including IVF and ambulatory surgeries. CMS’s recommendations aim to ensure that non-emergency healthcare resumes safely in areas that meet the Gating Criteria and that patients get the needed in-person treatment that may have been put off due to the public health emergency. The latest recommendations cover a range of topics to ensure patient and clinician safety, including facility considerations, testing and sanitation protocols, personal protective equipment and supplies, and workforce availability:

  • Optimization of telehealth services: Making effective use of telehealth can minimize the need for in-person services. This includes ensuring that individuals with disabilities have effective remote communication tools.
  • Care for at-risk populations: Populations at higher risk for severe COVID-19 illness include, but are not limited to, older adults (aged 65 and older) and people with serious underlying chronic conditions such as chronic lung disease, serious heart conditions (like congestive heart failure, coronary artery disease, and pulmonary hypertension), diabetes, severe obesity, moderate-to-severe asthma, liver disease, hemoglobin disorders and compromised immune function. CMS recommends that vulnerable and other populations who may need to take precautions shelter in place.
  • Specific guidance for in-person care for non-COVID-19 patients: When care cannot be provided via telehealth, steps should be taken reduce the risk of COVID-19 exposure and transmission in any newly created NCC areas.
  • Workforce and resources: To safely deliver in-person care to patients requiring NCC, careful planning is required. Facilities need to ensure that they have the resources and workforce to deliver all aspects of care (including clinicians, nurses, anesthesia, pharmacy, imaging, pathology support, and post-acute care).

CMS lists the key factors that hospitals and other providers should consider prior to resuming non-emergent care as:

    • A low or downward trend of COVID-19 patients in the facility or region, as applicable

Prioritizing the following based on clinical needs:

    • Services that, if deferred, can result in patient harm.
    • At-risk populations who would benefit most from those services (such as those with serious underlying health conditions, those most at-risk for complications from delayed care, or those without access to telehealth).
  • Suitable personal protective equipment (PPE)
  • Separate COVID-19 treatment areas
  • Adequate SARS COV-2 pre-screening or testing capabilities for patients and staff.
  • Minimizing visitors, and if allowed, assessing them for COVID-19 symptoms upon entry to the facility
  • Sanitation protocols – thorough cleaning and disinfection prior to using spaces or facilities for patients with NCC needs

Recommendations for Patients

Patients need to know when it is safe to return to healthcare facilities, and what to expect when they do. CMS issued the following recommendations to help guide patients as they consider seeking non-emergency care:

  • Do not postpone urgent care: CMS cautions patients against postponing care that is urgent or may lead to complications such as heart attack or stroke or necessary preventive care such as immunizations or cancer screening.
  • Check whether it’s safe to go to hospital: Healthcare providers have been instructed to take all appropriate precautions to ensure that care is as safe as possible for patients. Patients should ensure that they know about the safety measures taken by their provider’s facility.
  • Consider Telehealth or Virtual Visits: Telehealth minimizes the risk of transmission of Covid19. Patients should ask their provider if virtual visits are an option.
  • Know the safety protocols associated with an office visit: Providers may instruct patients to wear a face mask, limit the number of people who accompany them to the hospital, avoid crowded areas, undergo screening before entering the facility, and wash hands frequently.
  • Testing for COVID-19: Patients should also discuss with their provider if they should get tested for COVID-19 before seeking healthcare. Testing may be necessary before surgery, childbirth, or a procedure.

CMS advises high-risk patients including those with underlying chronic conditions such as high blood pressure, diabetes, kidney disease, or those who are over 65 years of age, to stay home as far as possible. If they do go outside, they should avoid crowds and practice social distancing by staying 6 feet away from others.

Outsourced Medical Billing for Efficient RCM Support

Health care facilities experienced a significant drop in revenue as a result of postponed or cancelled treatments. A TransUnion Healthcare analysis of more than 500 U.S. hospitals found a 32% – 60% decline in visit volumes between the weeks of March 1 and March 29, compared against pre-COVID-19 volumes ( As patients return, providers need to focus on reassuring them and re-establishing normal operations. Outsourced medical billing services can help facilities get back on track financially.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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