August 24, 2020

CMS to increase pay to hospitals for care of COVID-19 patients

By: Judy Mathias

Editor's Note

The Centers for Medicare & Medicaid Services (CMS) on August 17 updated its patient payment guidance to increase hospital reimbursement for care of COVID-19 patients by 20%. The payment increase will take effect September 1.

Among requirements for hospitals to receive the Medicare payment increase:

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  • Patients must have a COVID-19 test, consistent with Centers for Disease Control & Prevention guidelines, taken within 14 days of hospital admission.
  • Tests performed by a local government-run testing center may be manually entered into the patient’s medical record.
  • When a test is performed more than 14 days before admission, CMS will consider complex medical factors in addition to test results in meeting the documentation requirement.
  • CMS may conduct a post-payment review to confirm a positive COVID-19 test. If a positive test isn’t in the patient’s medical record, CMS will recoup the payment increase.

This update was made in relation to implementation of Section 3710 of the CARES Act for Inpatient Prospective Payment System hospitals to address potential Medicare program integrity risks.


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