HCA Announces 20 Percent Add-on Payment for Medicaid COVID-19 Admissions

August 12, 2020

WSHA has been in discussions with HCA for several months with a request to increase payment for COVID cases. We are pleased that  August 10, HCA announced  it received CMS approval to temporarily pay an enhanced payment rate for Medicaid COVID-19 inpatient claims. The change will result in a 20 percent increase in payment for COVID-19 inpatient services paid under HCA’s all-payer-refined DRG methodology and is consistent with Medicare payment policy for inpatient COVID cases. The enhanced payment is effective retroactive to March 1 and through the remainder of the declared state of emergency.  It applies to both Medicaid fee-for-service and Medicaid managed care claims. HCA has already programmed ProviderOne for the payment enhancement, and the managed care plans already have or soon will have their systems set up to pay the higher payment amount.

The enhanced payment will apply to inpatient cases billed with an appropriate COVID-19 diagnosis and “DR” condition code. Hospitals that billed prior services without the appropriate diagnosis code and/or condition code or submitted the claim prior to payor programing can bill HCA or the managed care organization as an adjusted claim to receive the enhanced payment. More information is in HCA’s Provider Alert.

WSHA also requested HCA consider separate payment for Remdesivir, which can cost hospitals more than $3200 for a course of treatment and would be bundled into the inpatient DRG payment.  In addition, WSHA requested separate payment for COVID-19 testing, which is typically bundled into the payment for the emergency department or clinic visit. At this point HCA indicated it cannot commit to additional payment for these services due to the state’s budget situation during the COVID-19 emergency. (Andrew Busz, andrewb@wsha.org ).


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