COVID-19 Billing Updates for Hospitals

Many hospitals are treating Covid-19 patients. CMS has recently issued new Covid-19 Billing Updates for hospitals. This new update explains reimbursement and coding policies for hospitals treating Covid-19 patients and alternate care sites created by hospitals during the pandemic.

Financial Support for Providers during Covid-19

President Trump signed the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) into law on March 27, 2020. The law, which established new stimulus and aid programs, will provide more than $2 trillion in emergency economic relief to individuals and businesses affected by the coronavirus crisis. ASCO provided a resource guide to help members in accessing critical support needed to sustain the care of patients with cancer.

This information is subject to change as federal agencies continue to update and provide advisory guidance on these programs; and as the new regulation is enacted by Congress and the White House.

Utilizing the CARES Act funding, states will be required to perform on-site surveys of the nursing homes before and after Covid-19 outbreaks. After Covid-19 outbreaks should be performed within three to five days of identification.

CMS updated FAQs on Medicare fee-for-service billing during the COVID-19 emergency. Many questions are centered on Hospital Inpatient Prospective Payment System payments made under the Coronavirus Aid, Relief, and Economic Security (Cares) Act.

The CARES Act allocated billions of dollars in relief to hospitals and other healthcare providers. This allocation includes a temporary 20% increase in hospital IPPS reimbursements for Covid-19 patient’s hospitalizations during the emergency period.

The updated FAQs clarify how the agency can identify Covid-19 discharge and whether hospitals need to provide special codes to get the maximum payment.

CMS will not implement new Medicare Severity – Diagnosis Related Group weights to give a temporary payment boost. The agency can use the IPPS pricer to apply the adjustment factor to increase the MS-DRG relative weight. That would otherwise apply by 20% when identified IPPS operating payments.

These payments include calculation of reimbursements for disproportionate share hospitals, indirect medical education, outliers, new technologies, and low-volume hospitals, as well as the hospital-specific rates for sole community hospitals and Medicare-dependent hospitals.

CMS clarified in the updated FAQs that hospitals are not required to use the DR condition code on claims to Medicare fee-for-service to receive an increased IPPS rate. MACs will also start reprocessing claims for Covid-19 hospitalizations submitted prior to the passage of the CARES Act, the agency stated.

CMS Flexibilities to Fight COVID-19

CMS issued an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. These temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. The goals of these actions are to:

  • Expand the healthcare system workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the community or from other states;
  • Ensure that local hospitals and health systems have the capacity to handle a potential surge of COVID-19 patients through temporary expansion sites (also known as CMS Hospital Without Walls)
  • Increase access to Telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home;
  • Expand in-place testing to allow for more testing at home or in community-based settings;
  • Put Patients Over Paperwork to give temporary relief from many paperwork, reporting, and audit requirements so providers, health care facilities, Medicare Advantage, and Part D plans, and States can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.