Several health care companies and hospital industry groups are fighting a battle for additional federal coronovirus reimbursement to test Trump administration policy, proving that patients are positive for Kovid-19, saying the requirement is wrongly called by Congress The relief established by denies the amount.
Legislation in March provided hospitals with a 20% increase in standard federal Medicare reimbursement for every patient admitted for coronavirus.
But the Centers for Medicare and Medicaid Services added a requirement, which took effect on 1 September. For hospitals to receive funding, each patient must have a documented positive Kovid-19 lab test.
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CMS officials said the requirement was added to prevent fraud from increasing funding. A spokeswoman said, “Under Medicare’s long-term standard payment policies, Medicare providers are required to document and bill for services based on the diagnosis of a beneficiary.”
CMS is concerned that someone without a lab test has a Kovid-19, hospitals may code them incorrectly because there is a virus and incorrectly receive 20% add-ons. The agency said it would review patient records after payments had been made to confirm positive test results, and payments for results that it lacked would be viewed as overpayments.
Evidence suggests that Kovid-19-related deaths may be overreported for patients with certain medical conditions in hospitals, such as end-stage renal disease and chronic kidney disease, August 20 by CMS Acumen, Burlingame, California according to the report. Provider of data analysis to government agencies.
Industry groups, including the American Hospital Association, which represents about 5,000 hospitals and health care providers, argue that if anything, many Kovid-19 cases run unknowingly. He said the new requirement is important because tests can sometimes give false negative results, and some people with Kovid-19 do not test positive if the exam is conducted 14 days after infection.
False negative rates for PCR or molecular tests – the most widely available test, which searches for the genetic content of viruses in nasal swabs or saliva samples – ranges from 2% to 37%. False positives are usually around 5% or less, but accuracy remains uncertain and results vary.
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Patients with long-term coronavirus health problems may not have a positive Kovid-19 test because they were infected in February or March, when the test was deemed to be of high-risk people, including seniors who were Kovid-19 and 19-year-olds. Were in contact medical staff. Hospital groups also said the policy incorrectly overrides doctors’ medical diagnoses and would lead to unnecessary retirements at a time when US testing capacity is already strained.
“It’s incredibly useless,” said Brian Gagnolati, president and chief executive officer of Atlantic Health System, which had 900 Kovid-19 patients in New Jersey hospitals in April. “There is a test problem in this country. The time it takes to get a test varies widely, and in some trials there is a false negative. It seems incredibly burdensome, and we are looking for another one this fall. Getting ready to pounce. ”
Some Republicans have recently raised questions about whether the increased funding presents an incentive for doctors to increase the Kovid-19 cases.
Hospital groups and doctors said they are being mistreated unfairly as they increase resources to combat coronovirus, and say they are losing money. They also raise concerns about whether there has been sufficient oversight for federal incentive funds and grants to providers. HHS is distributing $ 175 billion to hospitals and health care providers on the front lines of coronovirus response.
“You need to jump through hoops to get them paid, and that’s unfair,” said Tom Nickels, executive vice president of government relations and public policy at the AHA.
The 20% add-on payment applies to patients admitted to hospitals for Kovid-19 treatment and who are on Medicare, a federal health insurance program for people 65 years of age or older or whose Have specific disabilities. In April CMS indicated that documentation from a doctor was all that was needed to boost funding. Under the new requirement, a laboratory test must be done before or during admission.
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If there is no positive test in the patient’s medical record, the agency can audit and review and withdraw the add-on money. CMS has stated that it will look into medical factors other than a test if the test was done 14 days prior to admission according to the agency’s guidance.
Some hospital leaders said they are worried that the epidemic will reduce at a time of historical financial pressure. He also said that add-on payments still do not cover their costs for treating Kovid-19 patients, as Medicare reimbursement marks private insurance reimbursement.
According to CMS’s August 26 letter from the Hospital Association, “It is not only cumbersome and potentially useless, but it can also lead to prolonged stay in the hospital, additional costs to patients and additional inconvenience to patients.” . ”
According to CMS data, a total of 101,348 discharges and total payments through May totaled $ 2.286 billion, with an average Medicare reimbursement of $ 22,556 per Kovid-19 discharge. For comparison purposes, average Medicare spending in the first quarter of 2020 was $ 13,677 per discharge.
CMS is making other efforts aimed at ensuring accountability for taxpayer dollars, including a proposal for new reporting requirements in Medicaid, a federal-state program for low-income and disabled people. It also follows criticism from Democrats who say HHS has not provided adequate oversight on coronovirus relief grants made to health care providers. The HHS Office of Inspector General is auditing the distribution of grants.
Many patients hospitalized for Kovid-19 are on Medicare because the virus has a more serious medical impact on seniors. According to the Centers for Disease Control and Prevention, people between the ages of 65 and 74 are hospitalized at a rate five times higher than children aged 18 to 29.
More benefits have been seen in the hospital’s larger population since the epidemic, but hospital groups said they are particularly concerned with the financial impact of the virus. In May the AHA estimated that the four-month financial impact of coronovirus was a $ 200 billion deficit for hospitals and health systems. Hospitals had to pay for personal protective equipment and saw a decline in revenue as alternative procedures were initially postponed due to the virus.