Inpatient Hospital - Temporary enhanced rate increase for COVID-19-related DRG claims

Washington State Health Care Authority sent this bulletin at 08/10/2020 02:17 PM PDT

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Apple Health (Medicaid) Provider Alert

Attention Inpatient Hospital providers:

What is changing?

Retroactive to dates of service on and after March 1, 2020, until further notice, inpatient hospital claims paid under the diagnosis related group (DRG) pricing methodology (including DRG high outlier and transfer case pricing) are approved for a 20% increase in payment for services related to the treatment of COVID-19. This enhanced payment will continue until the declared state of emergency is discontinued.

How do I bill to receive the enhanced payment?

In order to qualify for the enhanced payment, the inpatient hospital claim must pay under the DRG pricing methodology. For the admission dates of:

3/1/2020 through 3/31/2020, bill claims with condition code DR and diagnosis code B97.29.
4/1/2020 until the declared state of emergency is discontinued, bill claims with condition code DR and diagnosis code U071.

How do I receive the enhanced payment if I have already billed?

If you have already billed inpatient hospital claims for dates of service 3/1/2020 to the present that included services related to the treatment of COVID-19 but did not include the condition code DR, please resubmit or adjust (if paid) these claims for correct payment.

Where else can I find this information?

You can find this information on the Health Care Authority’s (HCA) Information about novel coronavirus (COVID-19) webpage, under Providers, Billers, and Partners, Apple Health (Medicaid) Inpatient Hospital Rate Increase for COVID-19 Related Services. We are also updating the Inpatient Hospital Billing Guide, dated August 10, 2020, to include a note about this enhanced rate increase.

Questions can be directed to hcahospitalrates@hca.wa.gov.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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