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Medicare DRG Increases for COVID-19 Treatment Services Under Coronavirus Aid, Relief, and Economic Security (Cares) Act

Date: 06/15/20

The Centers for Medicare & Medicaid Services (CMS) have released guidance for implementing several provisions included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. MeridianTotal (Medicare-Medicaid Plan) will be following this guidance as we adjudicate Medicare claims for applicable COVID-19 inpatient treatment services.

The CARES Act provides for a 20% increase to the inpatient prospective payment system (IPPS) Diagnosis Related Group (DRG) rate for COVID-19 patients for the duration of the public health emergency. The increase will be applied to claims that include the applicable COVID-19 ICD-10-CM diagnosis code and meet the date of service requirements, as follows:

For discharges with the diagnosis codes above, MeridianTotal will follow the Medicare billing guidance published by CMS. Inpatient claims for these COVID-19 discharges that have already been received will be automatically reprocessed to reflect the payment increase.

This guidance is in response to the COVID-19 pandemic and may be retired at a future date.

Sources:

The Centers for Medicare and Medicaid (CMS)

The Centers for Disease Control (CDC)