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Does Your Hospital Qualify For COVID-19 Medicare Pay Hike?

September 1, 2020

Starting on September 1, hospitals that have cared for patients who are Medicare beneficiaries diagnosed with COVID-19 will see a 20% boost in payments if they prove a positive diagnosis, CMS announced on Aug. 17.

The pay hike comes from a provision in the CARES Act that directed the Department of Health and Human Services (HHS) to increase pay for hospitals caring for these Medicare beneficiaries during the COVID-19 public health emergency.

At Coronis Health, we understand that it is of critical importance for hospital administrators and practice managers to remain constantly vigilant and compliant amid the changing chorus of governmental/carrier billing, documentation regulations, and compliance requirements. With 100+ years of combined experience, our use of industry-leading technology, and our high-touch relationship building, we can provide specialized solutions for your health systems, helping you focus on patient care, maintaining financial independence, and cultivating financial success.

New COVID-19 Policies

The following are the new COVID-19 Policies for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act, from the Centers for Medicare & Medicaid Services (cms.gov):

  • Effective with admissions occurring on or after September 1, 2020, claims eligible for the 20 percent increase in the MS-DRG weighting factor will also be required to have a positive COVID-19 laboratory test documented in the patient’s medical record. Positive tests must be demonstrated using only the results of viral testing (i.e., molecular or antigen), consistent with CDC guidelines. The test may be performed either during the hospital admission or prior to the hospital admission.
  • A viral test performed within 14 days of the hospital admission, including a test performed by an entity other than the hospital, can be manually entered into the patient’s medical record to satisfy this documentation requirement. For example, a copy of a positive COVID-19 test result that was obtained a week before the admission from a local government-run testing center can be added to the patient’s medical record. In the rare circumstance where a viral test was performed more than 14 days prior to the hospital admission, CMS will consider whether there are complex medical factors in addition to that test result for purposes of this documentation requirement.
  • The Pricer will continue to apply an adjustment factor to increase the MS-DRG relative weight that would otherwise be applied by 20 percent when determining IPPS operating payments for discharges that report the ICD-10-CM diagnosis code U07.1 (COVID-19). CMS may conduct post-payment medical review to confirm the presence of a positive COVID-19 laboratory test and, if no such test is contained in the medical record, the additional payment resulting from the 20 percent increase in the MS-DRG relative weight will be recouped.
  • A hospital that diagnoses a patient with COVID-19 consistent with the ICD-10-CM Official Coding and Reporting Guidelines but does not have evidence of a positive test result can decline, at the time of claim submission, the additional payment resulting from the application at the time of claim payment of the 20 percent increase in the MS-DRG relative weight to avoid the repayment. To do so, the hospital will inform its MAC and the MAC will notate the claim with MAC internal claim processing coding for processing. The Pricer software will not apply the 20 percent increase to the claim when that MAC internal claim processing coding is present on a claim with the ICD-10-CM diagnosis code U07.1 (COVID-19). The updated Pricer software package reflecting this change will be released in October 2020, and additional operational guidance will be provided in implementation instructions in the near future.

Why Seek Assistance From a Healthcare Revenue Cycle Management Company

Keeping the billing office running during this pandemic is key to keeping all types of hospitals and surgical centers open for infected patients requiring care. We know this can be a challenge, especially for independent and smaller organizations, as well as critical access hospitals. By outsourcing your billing and coding, you can focus on your patients while we handle the coding for you. Coronis Health’s is an experienced medical billing and coding company well-versed with the most current changes in healthcare laws and regulations. This way, you can be sure your coding is being handled accurately and that you’re being compensated appropriately for the services you provide. Our use of cutting edge tech, personalized service, and global capabilities means you’re receiving unprecedented care and attention.

At Coronis Health, we know that your most important financial asset is your billed services and accounts receivable. This asset needs to be safeguarded, well-organized, tightly managed, and carefully maintained by a professional team possessing a perfectionist approach to execution, accuracy, follow-up, and timeliness. We will deliver exceptional, personalized service, and with our scalable capabilities, we can service your practice as it grows.

Find Out How Coronis Health Can Serve You

COVID-19 is creating challenges not just around the healthcare revenue cycle but also in resource allocation and patient financial responsibility. To learn more about how a healthcare revenue cycle management company can be of assistance to your hospital during this time and how our thought leadership can help your medical practice reach the next level of financial success, contact Coronis Health today and schedule your free financial checkup.

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