Quote:
Originally Posted by JMintzer
Here is a quote from the article (Link to entire article posted below)...
"Inpatient novel coronavirus (COVID-19) claims will require a positive viral test result to be eligible for the 20% increase in the MS-DRG weighting factor, effective for admissions on or after September 1. The test must be performed within 14 days of admission, and the results must be documented in the patient’s medical record."
Notice they said ON or AFTER September 1... Before that, no positive test was required. Only an assumption of Covid... Yes, so noted. But neither the Hospital Administrators nor billing clerks can add a Covid diagnosis, assumed or proven, to a patient's medical record, that comes from the doc. And a signed order from a doc/authorized designee is required for any testing, including Covid testing. Hospital admins don't routinely access medical records, and billing clerks (coders) bill only based on the documentation in the record. Compliance is my gig, I know that's how it works. So I'm still not understanding why you don't blame physicians, instead blaming hospital admin and billing clerks for the Covid dx.
CMS Will Require Positive COVID-19 Test Results for Increased Inpatient Payment | HealthLeaders Media |
From your article: "However, organizations should prepare to comply with the new requirement by September 1. Organizations must ensure processes are in place to obtain accurate test results for all COVID-19 admissions. Clinical, HIM, CDI, and billing staff should be informed of the change, and coders and CDI specialists should query for missing test results. Organizations may need to review processes for obtaining test results from outside entities and should consider processes for holding inpatient COVID-19 claims that are pending test results. Organizations should reach out to their MACs to discuss operational and technical questions."
Or are you suggesting hospital administration should not seek out permissible payments? No way, I don't think that's what you meant, you'd never pass up the same opportunity within your business (i.e. private practice).