Course | Basic | Medicare Payment and Reimbursement
In this course we will address scheduling processes, including<div><ul><li>Patient identification</li><li>Requested service</li><li>Medical necessity screening</li><li>Medicare Advance Beneficiary Notice of Noncoverage processing</li><li>Pa...
Course | Overview | Medicare Payment and Reimbursement
This course provides a brief history and overview of Medicare and Medicaid. It describes government organizations that regulate and administer this program. This course also discusses Medicare reimbursement. In addition, it highlights recen...
Course | Intermediate | Medicare Payment and Reimbursement
This course provides an overview of the prospective payment systems used in the Medicare program and as well as Medicare fee schedules. This course provides a general discussion and overview of Medicare reimbursement under the Inpatient Pro...
Course | Intermediate | Medicare Payment and Reimbursement
This course provides a general discussion and overview of reimbursement provided by Medicare under the outpatient prospective payment system. It also discusses the use of ambulatory payment classifications in the outpatient prospective paym...
On Demand Webinar | Intermediate | Medicare Payment and Reimbursement
As the senior population continues to outpace the relative growth of the general population, and Medicare Advantage is accounting for about one-third (and growing every year) of all new Medicare eligible enrollees, providers are increasingl...
News | Medicare Payment and Reimbursement

Increased Medicare payments for COVID-19 care to stretch back to late January

News | Medicare Payment and Reimbursement

Increased Medicare payments for COVID-19 care to stretch back to late January

Medicare will provide hospitals and long-term care hospitals (LTCHs) a retroactive increase in payments for care provided to COVID-19 discharges as reflected on claims dating back to Jan. 27, the agency says.

CMS this week will begin sending a 20% increase in Inpatient Prospective Payment System (IPPS) payments for patients previously treated for COVID-19 — far in advance of the latest quarterly update. The payments, as required by the CARES Act, will be automatically sent to previously paid providers that used the COVID-19 code (diagnosis code B97.29).   

CMS on April 21 will start to increase inpatient hospital payments by 20% for Medicare claims related to the care of COVID-19 patients on April 1 or later (diagnosis code U07.1).

Also on April 21, LTCHs will be paid the LTCH standard federal rate — instead of the site-neutral rate — for all cases, even those that don’t meet the criteria of three days in the ICU in an IPPS hospital or assignment to a mechanical ventilation DRG in the LTCH for more than 96 hours.

LTCHs also will be paid retroactively to Jan. 27 at the LTCH standard federal rate. 

Also waived by CMS were:

  • The LTCH "50% Rule," which sets the minimum share of discharges required to be paid at LTCH rates rather than site-neutral rates
  • The inpatient rehabilitation facility (IRF) “3-hour Rule,” related to the amount of rehabilitation in which Medicare Part A fee-for-service patients must participate

FY21 proposed rules issued for IRFs, SNFs, hospice

CMS also recently issued a series of proposed rules, not related to COVID-19, to establish FY21 payment and policies for post-acute care providers.

Provisions of the IRF proposed rule included:

  • Increasing net payments by 2.5% ($270 million)
  • Ending the requirement for post-admission physician evaluation documentation for all discharges
  • Retaining the IRF quality reporting program without changes
  • Accepting comments through June 15

CMS had issued a March 31 interim final rule with a temporary waiver of the physician evaluation requirement for the duration of the COVID-19 public health emergency.

Provisions of the skilled nursing facilities (SNFs) proposed rule included:

  • Increasing aggregate payments by 2.3% ($784 million)
  • Revising geographic delineations used to identify providers as an urban or a rural facility for wage index calculations
  • Changing the ICD-10 code mappings used under the Patient Driven Payment Model
  • Tweaking the SNF Value-Based Purchasing program
  • Accepting comments through June 9

The hospice proposed rule included model examples of the required hospice election statement and the hospice election statement addendum.

Key provisions of the rule included:

  • Increasing hospice payments by 2.6% ($580 million)
  • Increasing the annual hospice cap to $30,743.86
  • Accepting comments through June 9

About the Author

Rich Daly, HFMA senior writer and editor,

is based in the Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare



Related Articles | Medicare Payment and Reimbursement

Blog | Bundled Payment

CMMI announcement foreshadows more mandatory bundled payment models

HFMA's Chad Mulvany says based on recently announced changes to BPCI-A episodes, a mandatory model may be defined much broader than currently.

Blog | Coronavirus

What can healthcare providers expect now that a COVID-19 relief package failed a procedural vote in the Senate

HFMA's Chad Mulvany says it’s not surprising the GOP's COVID-19 relief measure failed, given the package was negotiated without input from Democrats.

Fact Sheet | Payment, Reimbursement, and Managed Care

FY21 Inpatient Prospective Payment System Final Rule Summary

HFMA presents a comprehensive summary of the FY21 IPPS final rule, released by CMS.

Blog | Innovation and Disruption

Why Walmart is partnering with Oak Street on three in-store clinics in the Dallas-Fort Worth area

HFMA's Chad Mulvany says Walmart's partnership with Oak Street is due to Oak Street’s reputation for developing a patient-centric care model.