Avoid Potential Impact on COVID-19 Claims Reimbursement: Following Guidelines for Consistent Coding of Inpatient Claims will Ensure Proper Reimbursement.

Recently, congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provides more than $100 billion in direct aid to hospitals and other providers. This includes a 20 percent increase in reimbursement for inpatient COVID-19 claims.  

Hospitals are being advised to hold any inpatient COVID-19 claims if testing is performed, and the results are not returned at the time the inpatient record is coded. 

• On or after April 1, 2020, and through the duration of the COVID-19 Public Health Emergency, any inpatient claims must have U07.1 on the claim, either as a principal or secondary code.  Official Coding and Reporting Guidelines can be accessed HERE
• Any inpatient claims prior to April 1 must have B97.29 (January 27th to March 31, 2020) on the inpatient claim to receive the additional reimbursement. ICD-10-CM Official Coding Guideline/Supplement can be accessed HERE

​The program memorandum can be accessed here, which includes information released on April 15, 2020.  Many hospitals have been holding COVID-19 claims regardless, due to the fluid environment for which coding guidelines have been updated or released. If this has not been the practice at your organization, it may be necessary to run data on COVID-19 inpatient records to ensure the coding of inpatient COVID-19 claims are consistent with the above coding instructions and the applicable dates.    
 
AHIMA and AHA have provided the direction to rebill any inpatient claims that were billed without the above-noted guidelines.  As an example, if an inpatient record is coded and a test result is returned after the initial claim has been submitted stating the patient is positive for COVID-19, the account can be rebilled with the appropriate code noted above; it is not necessary to query the physician.

Access the new revision announcement and complete review of New Waivers for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act.

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