AHA urges flexible approach to new CMS documentation requirement

AHA today urged the Centers for Medicare & Medicaid Services to provide flexibility regarding the agency’s new COVID-19 test documentation requirement for the diagnostic-related group add-on payment.

“This new requirement will put substantial administrative burden on hospitals at a time when they are focusing their efforts and resources on critical patient care,” the association wrote. “Thus, we urge CMS to allow provider documentation to suffice if the test result is unavailable.”

The Coronavirus Aid, Relief, and Economic Security Act provided a 20% add-on to the inpatient prospective payment system DRG rate for patients diagnosed with COVID-19 during the public health emergency. CMS recently added a requirement to have a positive COVID-19 laboratory test documented in the patient’s medical record in order for the claim to be eligible. The new requirement would be applied to admissions on or after Sept. 1, 2020.

“We have heard from our hospital members that acquiring test results from other health care providers, local testing centers and other third party entities can be a burdensome process, sometimes resulting in long delays or unobtainable results,” the letter notes. “In order to receive the add-on payment, hospitals would have to dedicate considerable time and effort to obtain a patient’s third party result to manually add into the medical record, and in some cases would ultimately have to re-test the patient.”