Current Report Articles
CMS Issues New Requirement for DRG Add-On

CMS (Aug. 28, 2020) – The Coronavirus Aid, Relief, and Economic Security Act provided for a 20 percent add-on to the inpatient prospective payment system diagnosis-related group rate for patients diagnosed with COVID-19 for the duration of the public health emergency. On Aug. 17, the Centers for Medicare & Medicaid Services updated guidance related to this add-on payment.

To address what CMS indicates as potential Medicare program integrity risks, effective with admissions occurring on or after Sept. 1, 2020, claims eligible for the 20 percent increase in the MS-DRG weighting factor also will be required to have a positive COVID-19 laboratory test documented in the patient's medical record. The test may be performed either during the hospital admission or within 14 days prior to the hospital admission. Further details are outlined in MLN Matters SE20015.
--Tish Hollingsworth