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Analysis

CMS Releases New COVID-19 Billing FAQs

By Revenue Cycle Advisor  
   June 01, 2020

CMS states that it did not create new MS-DRG weights to implement the 20% increase in the MS-DRG weight provided by the CARES Act.

A version of this article was first published June 1, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

CMS on May 27 released new novel coronavirus (COVID-19) Medicare billing FAQs to address questions related to payment for inpatient services billed during the public health emergency (PHE).

The new FAQs are in Section F (Hospital Inpatient Prospective Payment Systems [IPPS] Payments under the CARES [Coronavirus Aid, Relief, and Economic Security] Act) of the document and address the following topics:

  • ICD-10-CM coding for COVID-19 discharges.

According to CMS, coders should report ICD-10-CM code 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. They should report code U07.1 (COVID-19) for discharges occurring on or after April 1, 2020, through the duration of the COVID-19 PHE.

  • Potential changes to MS-DRG weights under the IPPS because of the CARES Act.

CMS states that it did not create new MS-DRG weights to implement the 20% increase in the MS-DRG weight provided by the CARES Act. Instead, in accordance with section 3710 of the Cares Act, for discharges during the COVID-19 PHE, the agency 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.

  • Estimated MS-DRG payments under the IPPS, including the adjustment provided by section 3710 of the CARES Act, for patients diagnosed with COVID-19.

On page 18 of the document, CMS offers examples to illustrate the increase in IPPS operating MS-DRG payments provided by the CARES Act for patients diagnosed with COVID-19, for discharges occurring on and after January 27, 2020, and on or before March 31, 2020.

On page 20 of the document, CMS offers examples to illustrate the increase in IPPS operating MS-DRG payments provided by the CARES Act for patients diagnosed with COVID-19, for discharges occurring on or after April 1, 2020, through the duration of the COVID-19 PHE period.

CMS also added new FAQs on the following topics:

  • Rural health clinics and federally qualified health centers (Section I)
  • Medicare telehealth (Section L)
  • Outpatient therapy services (Section FF)

Revenue Cycle Advisor combines all of HCPro's Medicare regulatory and reimbursement resources into one handy and easy-to-access portal. News is not just repeated from other sources. It is analyzed by our Medicare experts so professionals can comprehend any new rule and regulatory updates thoroughly. Learn more.


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