Challenge accepted....
This article is so misleading it should be listed as Fake News. The article doesn't say physicians are putting COVID patients on vents unnecessarily to get extra money, but it does try to hint that there is an incentive for a hospital/physician to game the system by diagnosing COVID. They clearly have no clue how Medicare reimburses.
Medicare has a base rate (adjusted for geography and other factors) multiplied by a Severity Adjusted Diagnosis Related Group. So if the base rate is around $6000 and the DRG has an acuity of 1.5, the hospital is going to get paid $9,000. Its actually very simple and predictable.
Medicare never has reimbursed for presumptive COVID, and they didn't even reimburse for positive COVID until April 1 when they recognized a COVID code. One of the criteria for being reimbursed with the COVID code
is a positive COVID test. So how do you think there is an incentive to game the system...faking a test?
Prior to April 1, all COVID positive and presumptive COVID was paid at the same rate as unspecified flu like systems. These groups of ICD-10 codes and DRGs do not have a "with complications" or "with major complications" acuity add on. So prior to April 1, every COVID patient was paid like they had a cold, even those that spent weeks on a vent.
Here are the guidelines for COVID reimbursement
https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf
Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result. For a confirmed diagnosis, assign code U07.1, COVID-19. This is an exception to the hospital inpatient guideline Section II, H. In this context, “confirmation” does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.
Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for COVID-19 is no longer required.
Here's how hospitals had to code prior to April 1. I'm sure you'll understand it.
https://www.cdc.gov/nchs/data/icd/I...ce-Interim-Advice-coronavirus-feb-20-2020.pdf