CMS Implements CARES Act Hospital Payment and Inpatient Rehabilitation Facility Waivers

April 17, 2020

CMS has implemented increased payment rates established by the CARES Act. Significantly, as they relate to Medicare IPPS Hospitals reimbursed under the Diagnostic Related Group (DRG) consolidated billing methodology, CMS is increasing the weighting factor of the assigned DRG by 20 percent for an individual diagnosed with COVID-19 discharged during the COVID-19 Public Health Emergency (PHE) period. IPPS Hospitals should ensure they use the specific ICD-10-CM diagnosis code in the billing for such patients:

  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere) for discharges occurring on or after January 27, 2020, and on or before March 31, 2020.
  • U07.1 (COVID-19) for discharges occurring on or after April 1, 2020, through the duration of the COVID-19 public health emergency period.

CMS is also waiving certain requirements for IRFs and LTCHs during the PHE. For IRFs, the 15 hours of therapy required for Part A inpatients is waived. For LTCHs, certain site neutral payment rate provisions are being waived. CMS has also included these updates in its lengthy (now lengthier) waivers document.

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