Looks like September 1st will be the magic day of miraculous decline of COVID-19 hospitalizations. Starting September 1st health care providers will have to show COVID-19 viral test positive results for hospitalized patients in order to get paid the 20% "add-on". If they can't produce said results within 14 days (including a test performed by an entity other than the hospital) and have already been paid, money will be recovered.
Link to download the pdf https://www.cms.gov/files/document/se20015.pdf
To address potential Medicare program integrity risks, effective with admissions occurring on or after September 1, 2020, claims eligible for the 20 percent increase in the MS-DRG weighting factor will also be required to have a positive COVID-19 laboratory test documented in the patient’s medical record. Positive tests must be demonstrated using only the results of viral testing (i.e., molecular or antigen), consistent with CDC guidelines. The test may be performed either during the hospital admission or prior to the hospital admission. For this purpose, a viral test performed within 14 days of the hospital admission, including a test performed by an entity other than the hospital, can be manually entered into the patient’s medical record to satisfy this documentation requirement. For example, a copy of a positive COVID-19 test result that was obtained a week before the admission from a local government- run testing center can be added to the patient’s medical record. In the rare circumstance where a viral test was performed more than 14 days prior to the hospital admission, CMS will consider whether there are complex medical factors in addition to that test result for purposes of this documentation requirement. The Pricer will continue to apply an adjustment factor to increase the MS-DRG relative weight that would otherwise be applied by 20 percent when determining IPPS operating payments for discharges that report the ICD‑10‑CM diagnosis code U07.1 (COVID-19). CMS may conduct post-payment medical review to confirm the presence of a positive COVID-19 laboratory test and, if no such test is contained in the medical record, the additional payment resulting from the 20 percent increase in the MS-DRG relative weight will be recouped.
Here is the link to download the pdf that seems to explain where the 20% add-on comes from. Very vague and it could be a complete coincidence that the estimated cost of a ventilated covid-19 patient is 20% higher than average non covid-19 patient.
Any help in interpreting this would be appreciated.
Link: https://www.aha.org/system/files/media/file/2020/05/aha-covid19-financial-impact-0520-FINAL.pdf
"The incremental cost of a COVID-19 hospitalization. For the second component, patients were segmented into two cohorts based on available clinical data: those who require mechanical ventilation and those who do not. Because mechanical ventilation use is often a sign of significant morbidity and impending mortality, the costs associated with its use are much higher than for patients who do not require that level of treatment. Therefore, total costs of treatment were estimated separately for patients who require mechanical ventilation and those who do not based on a set of corresponding diagnosis groups (DRGs) commonly used in payment for inpatient hospital services. These separate costs were then blended based on literature suggesting that only 20% of COVID-19 hospitalizations require ventilator use.29 Rather than focusing on the total cost of COVID-19 treatment, the incremental cost of a COVID-19 hospitalization was then calculated."