Starting next month, providers that want to get Medicare payments for treating a patient with COVID-19 must include a positive test in that patient’s medical record.
The Centers for Medicare & Medicaid Services released new guidance late Monday that aims to update how providers get paid for treating COVID-19 starting on Sept. 1. The impetus for the new change is to combat fraud, the agency said.
“The test must be performed either during the hospital admission or prior to the hospital admission,” the guidance said.
CMS said a viral test performed within 14 days of the patient’s admission can be manually entered into the patient’s record to satisfy this requirement. The test also does not have to be performed at the hospital but can be performed by another entity like a local health department.
If a test is performed more than 14 days prior to a hospital admission, CMS will consider if there are medical factors in addition to that test result to determine if the documentation requirement has been fulfilled.
Providers must use a viral test such as a molecular or antigen test that is consistent with Centers for Disease Control and Prevention guidelines.
CMS has applied a 20% add-on Medicare payment for both rural and urban inpatient hospital COVID-19 patients.
A hospital that diagnoses a patient with COVID-19 but doesn’t have evidence of the positive test result will not be able to get that 20% boost, the guidance said.
The guidance comes as testing delays have plagued some COVID-19 hot spots, with some local reports of longer lines and delays of more than a week for patients to get results.