The federally declared public health emergency (PHE), set to expire on October 23, was renewed and will remain due to the continued impact of the COVID-19 pandemic. The more relaxed regulatory rules regarding Medicare and Medicaid compliance associated with the PHE is no more, as healthcare provider’s ramp up preparedness with focus on internal processes.
In the early stages of the pandemic, CMS guidance indicated that a provider's documentation was sufficient to receive reimbursement from payers. The 20‐percent higher Medicare reimbursement for inpatient COVID treatment and a positive test result was not necessary. However, effective September 1, 2020, CMS has enlisted a mandate requiring hospitals to have positive COVID‐19 laboratory tests in patients' records to qualify for Medicare's 20‐percent add‐on payment. Suffice it to say, ensuring appropriate reimbursement for COVID-19 claims require careful management and attention to detail.