Beginning from next month, providers wanting to get Medicare payments to treat a patient with COVID-19 must include a positive test in that patient’s medical record.
The Centers for Medicare & Medicaid Services has released a new guidance that aims to update how providers will be paid for treating COVID-19 starting on September, 1. The stimulus for the new change is to be able to combat fraud, the agency explained.
This guidance impacts the social determinants of health and well being in a significant way.
The guidance mentioned that the test must be performed either during the hospital admission or prior to the hospital admission.
CMS said a viral test which is performed within the time span of 14 days of the patient’s admission could be entered manually into the patient’s record to fulfill the requirement. The test need not be performed at the hospital, but can be done by another entity like a local health department.
If a test is performed more than 14 days prior to have got admitted to the hospital, CMS would consider it, if there are medical factors in addition to that test result to decide if the documentation requirement has been met.
Providers have to use a viral test like a molecular or antigen test that is consistent with the guidelines of the Centers for Disease Control and Prevention.
CMS has put a 20% add-on Medicare payment for rural and urban inpatient hospital COVID-19 patients.
The hospital that diagnoses a patient with COVID-19 but, lacks to present evidence of the positive test result will be unable to get that 20% boost, the guidance mentioned.
The guidance is introduced as testing delays have continuously troubled some COVID-19 hot spots and there have been some local reports of longer lines and delays of more than a week for patients to get results.