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Has CMS clarified how providers should notify their MAC when submitting inpatient claims for COVID-19 patients who do not have a documented positive COVID-19 lab test in their record?

Effective September 1, 2020, CMS will require patients to have a documented positive COVID-19 lab test in order for facilities to receive the additional 20 percent increase to the MS-DRG weighting factor for inpatient COVID-19 claims. For a more detailed summary of this policy change please review our previous Q&A on this topic here.

CMS has since revised MLN Article SE20015 to provide instruction to providers on how they should notify their MAC at the claim level when there is no positive COVID-19 lab test for a given inpatient encounter. Per the guidance, providers should enter a Billing Note NTE02 “No Pos Test” when submitting electronic claims or add a remark of “No Pos Test” if submitting paper claims. These remark codes will alert the MAC that they should not apply the 20 percent increase to the weighting factor, even if COVID-19 diagnosis code U07.1 is present on the claim.

CMS MLN Matters Article SE20015:
https://www.cms.gov/files/document/se20015.pdf