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CMS adds 20% to inpatient Medicare payment for COVID-19 patients 

The guidance requires providers to document a positive COVID-19 test result in the medical record.

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services has announced new guidance regarding reimbursement of COVID-19 Medicare patients that will go into effect on September 1.

If a Medicare patient has been diagnosed with COVID-19 and needs to be admitted to a hospital, the payment to the hospital is increased by 20% to reflect the additional costs of treating a patient with COVID-19.  

To safeguard taxpayer dollars spent on this increased payment, CMS will now require that a positive COVID-19 laboratory test result is documented in the patient's medical record.  

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As needed, CMS will conduct post-payment medical review to confirm the presence of a positive COVID-19 laboratory test result. If the positive test result is not found in the medical record, the increased payment will be recouped by CMS as an overpayment.

WHY THIS MATTERS

The additional payment will help hospitals offset the cost of treating patients who have COVID-19, including the purchase of necessary supplies such as personal protection equipment. 

THE LARGER TREND

The Inpatient Prospective Payment System section of the CARES Act directs the Secretary of Health and Human Services to increase the weighting factor of the assigned Diagnosis-Related Group by 20% for an individual diagnosed with COVID-19 discharged during the COVID-19 public health emergency.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com