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Is there a special payment rate for COVID-19 Medicare inpatients?

On April 15th CMS released the MLN Matters Article “New Waivers for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act”, linked below. In the Article, CMS notes that Section 3710 of the recently passed CARES Act directs CMS to increase the weighting factor of Diagnosis-Related Groupers (DRGs) by 20% for individuals diagnosed with COVID-19 and discharged during the COVID-19 Public Health Emergency. CMS states it will identify inpatient claims where the 20% weighting factor increase is applicable based on the diagnosis code submitted on the claim:

  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere) for discharges occurring on or after January 27, 2020, and on or before March 31, 2020.
  • U07.1 (COVID-19) for discharges occurring on or after April 1, 2020, through the duration of the COVID-19 public health emergency period.

Please note, the article does not address how claims that have been previously submitted and processed will be handled; i.e. whether MACs will automatically reprocess these claims or if claims will need to be re-submitted. We will provide an update as soon as any additional guidance is released. You may also wish to contact your MAC directly for guidance on previously processed claims.

MLN Matters Article, “New Waivers for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act”:

https://www.cms.gov/files/document/se20015.pdf