CMS updates hospitals on COVID-19 billing policies: 5 things to know

CMS released several updates for hospitals on reimbursement and coding policies related to COVID-19 claims. 

Five things to know: 

1. In a frequently asked questions document on Medicare fee-for-service billing, CMS answered questions about how the Coronavirus Aid, Relief and Economic Security Act affects Hospital Inpatient Prospective Payment System payments. The document was most recently updated May 27.

2. CMS clarified how discharges for individuals diagnosed with COVID-19 are identified. The agency said COVID-19 patients will be identified by the presence of one of the following diagnosis codes: 

  • B97.29 for discharges occurring on or after Jan. 27, and on or before March 31
  • U07.1 for discharges occurring on or after April 1 through the duration of the COVID-19 public health emergency period

3. Other clarifications include how the CARES Act increases the IPPS weighting factor for the assigned diagnosis-related group by 20 percent for COVID-19 patients. CMS didn't create new Medicare Severity-Diagnosis Related Group weights to implement the increase. Rather, CMS will multiply the current MS-DRG relative weight for the discharge by a factor of 1.20 when calculating a hospital's operating IPPS payment.

4. Hospitals won't need a diagnosis-related condition code to receive the increased payment for IPPS discharges of COVID-19 patients.

5. CMS said by June 1, Medicare Administrative Contractors will automatically initiate the reprocessing of claims that were processed before implementation of provisions outlined in the CARES Act.

View the full updated FAQ sheet here

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