Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Awards
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
    • Women in Healthcare
    • - Luminaries
    • - Top 25 Diversity Leaders
    • - Leaders to Watch
    • - Luminaries
    • - Top 25 Women Leaders
    • - Women to Watch
  • Events
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Leadership Symposium
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Diversity Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Strategic Marketing
    • - Virtual Health
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Transformation Hub

Where healthcare challenges find solutions

  • Patients
  • Operations
  • Care Delivery
  • Payment
Payment
August 26, 2020 04:08 PM

CMS to require COVID-19 test results for 20% Medicare add-on payment

Tara Bannow
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Modern Healthcare Illustration / Getty Images

    Starting next week, CMS is requiring hospitals have positive COVID-19 laboratory tests in patients' records to qualify for Medicare's 20% add-on payment.

    The new rule, which CMS said seeks to address "potential Medicare program integrity risks," applies to admissions beginning Sept. 1. Until now, CMS guidance has said a provider's documentation—but not a positive test result—is sufficient to receive the 20% higher Medicare reimbursement for inpatient COVID treatment.

    CMS will continue to automatically apply the 20% add-on payment for COVID-19 claims after the rule takes effect. The agency will enforce the requirement through post-payment audits, with the extra 20% being recouped if no positive test results are found.

    Opinions vary on how much burden the new rule will place on providers, especially now that COVID-19 tests have become more widely available. Northwell Health, a 23-hospital system in New York that treated tens of thousands of COVID patients when the region was inundated early in the pandemic, already tests every patient who enters its hospitals, plus repeat tests if they initially test negative, said Dr. Mark Jarrett, Northwell's chief quality officer.

    "Quite frankly, I can understand why they want to ensure that people aren't labeling people with COVID when they're really not," he said.

    The American Hospital Association, by contrast, is asking CMS to walk back the new requirement. The lobbying group argued in a letter sent to CMS Administrator Seema Verma on Wednesday that requiring test results would put a "substantial administrative burden" on hospitals and provider documentation should continue to suffice.

    "Basing the COVID-19 diagnosis code on clinical judgment alone — in line with coding rules — continues to be an important approach given that test accuracy may not be reliable, re-testing is unnecessarily onerous, and some communities face persistent testing shortages," wrote Ashley Thompson, the AHA's senior vice president of public policy analysis and development.

    CMS did not respond to a request for comment.

    The accuracy of some tests has been largely unknown, especially after the FDA early on approved many quickly devised tests based on limited science. Even as COVID cases continue to surge, testing backlogs and extended turnaround times are not uncommon.

    In addition to a provider's confirmation, hospitals have until now been able to use state or local COVID-19 test results even if they weren't confirmed by the CDC to get the 20% add-on payment. That will no longer fly. The CMS now requires viral testing—meaning molecular or antigen—consistent with CDC guidelines.

    The two International Classification of Diseases, Tenth revision—ICD-10—codes used to identify COVID patients are U07.1 for discharges on or after April 1 and, before that, B97.29 for discharges on or after Jan. 27.

    The AHA warned that in some cases, hospitals might have to dedicate considerable time and effort trying to get test results from third-party providers and manually enter them into their medical records. In some cases, hospitals will ultimately have to retest the patients if they can't obtain the results.

    "This is not only unduly burdensome and potentially wasteful, but it also may lead to longer hospital stays, higher costs and additional discomfort for patients who are already suffering," AHA's Thompson wrote.

    Amanda Hayes-Kibreab, a healthcare partner with King & Spalding, said her hospital clients say COVID-19 tests are now much easier to access, and many are testing all patients suspected of having coronavirus, which makes the new CMS rule more workable.

    "Because testing is so much more available than it was, it may not have as significant an impact in practice," she said.

    Tags: Payment, Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), This Week in Healthcare, Coronavirus, Legislation & Regulation, Regulation, Finance, Northwell Health (formerly North Shore-Long Island Jewish), Enforcement & Compliance, Payment, Transformation, Transformation Hub
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    hospital-money_costs_i_i.png
    Employer health plans pay hospitals 224% of Medicare
    corona-hospital-money-mask_i.png
    5 ways COVID-19 shows up in CMS' proposed hospital pay rule
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate/Eligibility
      • 100 Most Influential People
      • 50 Most Influential Clinical Executives
      • Best Places to Work in Healthcare
      • Excellence in Governance
      • Health Care Hall of Fame
      • Healthcare Marketing Impact Awards
      • Top 25 Emerging Leaders
      • Top 25 Innovators
      • Diversity in Healthcare
        • - Luminaries
        • - Top 25 Diversity Leaders
        • - Leaders to Watch
      • Women in Healthcare
        • - Luminaries
        • - Top 25 Women Leaders
        • - Women to Watch
    • Events
      • Conferences
        • Transformation Summit
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Leadership Symposium
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Diversity Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Strategic Marketing
        • - Virtual Health
      • Webinars
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing