COVID-19: Medicare fee-for-service billing updates

COVID-19: Medicare fee-for-service billing updates

Recently, Centers for Medicare & Medicaid Services (CMS) upgraded a list of frequently asked questions on Medicare fee-for-service billing during the COVID-19 crisis. A number of questions focused on Hospital Inpatient Prospective Payment System (IPPS) payments made under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This act signed at the end of March 2020, as part of the CARES Act billions of dollars have been allotted in relief to hospitals and healthcare providers. In addition to this, the act has given a temporary 20% hike in hospital IPPS compensations specifically for COVID 19 care during the pandemic crisis.

The upgraded FAQs simplified how CMS has incorporated the hospital IPPS compensation hike, along with how CMS will find out COVID-19 discharges and in case of hospitals require to offer particular code to receive greater reimbursement.

In updated FAQs, CMS said that the CARES Act allowed the HHS Secretary to escalate the IPPS weighting factor for the allocated diagnostic-related group (DRG) for an independent diagnosed with COVID-19 discharged in the timeline of the public health emergency period. An upgraded FAQ said, the federal agency to find out who these independent depends on the ICD-10-CM diagnosis codes B97.29 and U07.1.

Implementation of the temporary payment hike

In order to implement the temporary payment hike, CMS won’t develop new Medicare Severity-Diagnosis Related Group (MS-DRG) weights. Instead of these weights, the CMS will utilize the IPPS Pricer to apply an adjustment factor to enhance the MS-DRG relative weight, which would alternatively apply by 20 percent when finding IPPS operating payments. Such kind of payments comprises low-volume hospitals, indirect medical education, calculation of reimbursements for disproportionate share hospitals, and outliers, as well as Medicare-dependent hospitals and hospital-specific rates for sole community hospitals.

How much reimbursement will hospitals receive?

How much hospitals will receive payments for COVID-19 hospitalizations will be based on the discharge date. CMS has given two new FAQs about the new payment rates for COVID-19 discharges taken place on or after January 27, 2020, and on or before March 31, 2020, as well as on or after April 1, 2020, through the duration of the COVID-19 public health emergency period.

In addition to the above updates, CMS also stated that Hospitals would not require utilizing the DR condition code on claims to Medicare fee-for-service to get an escalated IPPS rate. Furthermore, the agency explained that Medicare Administrative Contractors would also initiate reprocessing of claims for COVID-19 hospitalizations submitted before to the passage of the CARES Act.

Apart from this, other FAQs inscribed in 27th May 2020 updates contain explanations on distinctive waivers and exceptions, which only apply to hospitals reimbursed under TEFRA. Billing services for patients relocated to temporary acute care locations have to be functioned by public individuals during the COVID-19 crisis. Apart from COVID-19 billing updates for the IPPS, CMS published guidance on how hospitals can bill for services performed at different care sits generated to enhance their capacity during the COVID-19 crisis.

Creation of Care Sites

The permission has been given by CMS to the state and local governments, hospitals, and other organizations to develop different care sites, which means any building or structure can be used for healthcare. Some hospitals have utilized the flexibility of substitute care site to transform it into tents, cafeterias, other creative non-clinical spaces, and convention centers as well as retrofitted gymnasiums and other non-clinical locations for healthcare purpose.

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