Thursday, September 24, 2020
Home Insurance Hospitals oppose positive COVID-19 test requirement for more Medicare funding

Hospitals oppose positive COVID-19 test requirement for more Medicare funding

Many health-care firms and hospital trade teams are combating a Trump administration coverage tying additional federal coronavirus reimbursements to test outcomes proving that sufferers are positive for Covid-19, saying the requirement unfairly deprives them of aid cash established by Congress.

Legislation in March offered hospitals a 20% increase to the usual federal Medicare reimbursement for every affected person admitted for coronavirus.

But the Centers for Medicare and Medicaid Services added a requirement, which took impact Sept. 1: For hospitals to obtain the funding, every affected person should have a documented positive Covid-19 lab test.

Health care employees put together a COVID-19 test pattern. (David Santiago/Miami Herald through AP)


CMS officers mentioned the requirement was added to guard towards fraud for the reason that funding was elevated. “As part of Medicare’s longstanding standard payment policies, Medicare providers are required to accurately document and bill for services provided based on a beneficiary’s diagnosis,” a spokesman mentioned.

CMS is worried that with out a lab test displaying somebody has Covid-19, hospitals might code them incorrectly as having the virus and erroneously obtain the 20% add-on. The company mentioned that it’s going to evaluate affected person information after funds are made to verify positive test outcomes, and people missing outcomes would see their funds accounted for as overpayments.

Evidence means that hospitals might be overreporting Covid-19-related deaths for sufferers with sure medical situations, equivalent to end-stage renal illness and persistent kidney illness, in line with an Aug. 20 report back to CMS by Acumen, a Burlingame, Calif., supplier of knowledge evaluation to authorities businesses.

Industry teams together with the American Hospital Association, which represents almost 5,000 hospitals and health-care suppliers, argue that if something, many Covid-19 instances go undiagnosed. They mentioned the brand new requirement is important as a result of checks can generally yield false negatives, and a few folks with Covid-19 do not test positive if the examination is carried out 14 days after an infection.

False destructive charges for PCR or molecular checks — essentially the most extensively obtainable kind of test, which searches for the virus’s genetic materials in a nasal swab or saliva pattern — vary from 2% to as excessive as 37%. False positives are typically round 5% or decrease, however the accuracy stays unsure and the outcomes fluctuate.

CMS officers mentioned the requirement was added to guard towards fraud for the reason that funding was elevated. (iStock)


Patients with long-term coronavirus well being issues may not have a positive Covid-19 test as a result of they have been contaminated in February or March, when testing was restricted to folks deemed at larger threat, together with seniors, individuals who had been uncovered to Covid-19 and medical employees. Hospital teams additionally mentioned the coverage unfairly overrides docs’ medical diagnoses and can lead to pointless retesting at a time when U.S. testing capability is already strained.

“It’s unbelievably wasteful,” mentioned Brian Gragnolati, president and chief government officer of Atlantic Health System, whose hospitals in New Jersey had as many as 900 Covid-19 sufferers in April. “This country has a testing problem. The time it takes to get a test varies widely, and some of the tests have a false negative. This seems unbelievably burdensome, and we’re getting ready for another surge this fall.”

Some Republicans have raised questions just lately over whether or not the elevated funding presents an incentive for docs to inflate Covid-19 instances.

Hospital teams and docs counter that they’re being unfairly maligned as they stretch assets to grapple with the coronavirus, and say they’re dropping out on cash. They additionally increase issues about whether or not there was sufficient oversight of federal stimulus funding and grants to suppliers. HHS is distributing $175 billion to hospitals and health-care suppliers on the entrance traces of the coronavirus response.

“They require you to jump through hoops to get paid, and it’s a rigidity that’s unfair,” mentioned Tom Nickels, government vice chairman of presidency relations and public coverage on the AHA.

The 20% add-on cost applies to sufferers who’re admitted to hospitals for Covid-19 therapy and who’re on Medicare, a federal medical insurance program for people who find themselves 65 and older or have particular disabilities. CMS in April had indicated that documentation from a physician was all that was required for the funding increase. Under the brand new requirement, a lab test have to be carried out both earlier than or in the course of the admission.

Hospital teams and docs counter that they’re being unfairly maligned as they stretch assets to grapple with the coronavirus, and say they’re dropping out on cash. (iStock)


The company might conduct audits and evaluations and recoup the add-on cash if there isn’t any positive test within the affected person’s medical document. CMS has mentioned it could have a look at different medical elements along with a test if the test was executed more than 14 days earlier than admission, in line with the company steering.

Some hospital leaders mentioned they’re involved funding can be decreased throughout a time of historic monetary pressures due to the pandemic. They additionally mentioned the add-on cost nonetheless would not cowl their prices for treating Covid-19 sufferers, as a result of Medicare reimbursements path non-public insurance coverage reimbursement.

“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,” in line with an Aug. 26 letter to CMS from the hospital affiliation.

Through May, there have been a complete of 101,348 discharges and whole funds of $2.286 billion, for a mean Medicare reimbursement of $22,556 per Covid-19 discharge, in line with CMS knowledge. For comparability functions, the common Medicare spending within the first quarter of 2020 was $13,677 per discharge.

CMS is making different efforts aimed toward making certain accountability for taxpayer {dollars}, together with a proposal for new reporting necessities in Medicaid, the federal-state program for low-income and disabled folks. It additionally follows criticism from Democrats who say HHS hasn’t offered sufficient oversight over coronavirus aid grants made to health-care suppliers. The HHS Office of Inspector General is auditing the distribution of grant funding.

Many sufferers hospitalized for Covid-19 are on Medicare as a result of the virus has a more extreme medical influence on seniors. People who’re ages 65 to 74 are hospitalized at a charge 5 instances larger than 18-to-29-year-olds, in line with the Centers for Disease Control and Prevention.

Major for-profit hospital programs have seen larger earnings for the reason that pandemic started, however hospital teams mentioned they’re particularly anxious in regards to the monetary influence of the virus. The AHA in May estimated that the four-month monetary influence of coronavirus was $200 billion in losses for hospitals and well being programs. Hospitals needed to pay for private protecting gear and noticed revenues drop as a result of elective procedures have been initially postponed due to the virus.

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