With the COVID-19 pandemic ongoing, healthcare organizations continue to face catastrophic financial challenges. Drivers of the economic strain include the increased cost to care for patients with COVID-19, impact of canceled services, and additional costs—such as personal protective equipment (PPE) and the supplementary support some hospitals provide to their employees. During the pandemic era, getting paid appropriately for services is more important for health systems than ever. Recognizing these challenges to healthcare financial recovery, the federal government provides programs to give organizations financial relief, including add-on payment for patients diagnosed with COVID-19. To qualify for assistance, health systems must understand these relief programs and comply with their requirements.

1. HEALTHCARE FINANCIAL RECOVERY:
A GUIDE TO THE COVID-19 ADD-ON PAYMENT
Mikki Fazzio, RHIT, CCS

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Healthcare Financial Recovery
With the COVID-19 pandemic ongoing,
healthcare organizations continue to
face catastrophic financial challenges.
Drivers of the economic strain include
the increased cost to care for patients
with COVID-19, impact of canceled
services, and additional costs—such as
personal protective equipment (PPE)
and the supplementary support some
hospitals provide to their employees.

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Healthcare Financial Recovery
During the pandemic era, getting paid
appropriately for services is more
important for health systems than ever.
Recognizing these challenges to
healthcare financial recovery, the federal
government provides programs to give
organizations financial relief, including
add-on payment for patients diagnosed
with COVID-19.
To qualify for assistance, health systems
must understand these relief programs
and comply with their requirements.

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The 20 Percent Add-On Payment for
COVID-19 Patients
On March 27, 2020, The Coronavirus Aid,
Relief, and Economic Security (CARES)
Act was signed into law to assist hospitals
with additional payment for treatment of
patients with a diagnosis of COVID-19.

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The 20 Percent Add-On Payment for
COVID-19 Patients
Under CARES Act guidance, the Medicare
Hospital Inpatient Prospective Payment
System add-on payment for COVID-19
patients during the emergency period
states that a discharged individual with a
COVID-19 diagnosis will receive a 20
percent increase in the weighting factor of
the diagnosis related group (DRG) to
which they (the discharged individual) are
categorized.
Payment, however, isn’t automatic.
Organizations need to know the rules and
regulations around receiving COVID-19
financial relief.

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
The following three requirements will help
health systems ensure add-on payments for
patients diagnosed with COVID-19:
1. Include a copy of the positive COVID-19
laboratory result in the medical record
2. Create internal policies for COVID-19 results
from more than 14 days before admission
3. Document and appropriately code the
COVID-19 diagnosis

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
Health systems must include a copy of the
positive COVID-19 laboratory result in the
patient’s medical record.
This result can be from another facility prior
to hospital admission but should typically be
obtained within 14 days of admission.
1. Include a Copy of the Positive COVID-19
Laboratory Result in the Medical Record

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
If the result is from more than 14 days before
admission, CMS will review the case to
determine if any medical conditions led to
the admission. The provider must also
document these conditions.
Clinical documentation integrity (CDI)
specialists can assist with the documentation
requirement by reviewing cases at the time
of admission for patients claiming a positive
test at another facility.
1. Include a Copy of the Positive COVID-19
Laboratory Result in the Medical Record

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
If a provider can’t get the initial result, the CDI
specialist can also obtain a copy of the lab
result for the medical record or speak with the
physician about repeating the COVID-19 test.
1. Include a Copy of the Positive COVID-19
Laboratory Result in the Medical Record

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
Organizations should create internal policies for
handling cases with lab results from more than
14 before admission.
For example, for COVID-19 complications that
can occur weeks or months after the initial
COVID-19 positive result, such as deep vein
thrombosis or pulmonary emboli, organizations
need to determine whether the code for an
active COVID-19 is appropriate.
2. Create Internal Policies for COVID-19 Results
from More than 14 Days Before Admission

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
In some cases, it may be correct to instead
assign a code for a personal history of
COVID-19 (Z86.19).
A good indicator of when to use an active
COVID-19 code is whether the organization
followed its isolation protocol.
2. Create Internal Policies for COVID-19 Results
from More than 14 Days Before Admission

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
If the health system did not expend additional
resources to care for the patient in isolation,
it shouldn’t use the active COVID-19 and
doesn’t qualify for additional payment.
In this instance, a personal history of
COVID-19 code is likely more appropriate.
2. Create Internal Policies for COVID-19 Results
from More than 14 Days Before Admission

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
Providers must document and appropriately code
COVID-19 diagnoses following the ICD-10-CM
Official Guidelines for Coding and Reporting.
The positive lab result alone is not enough to
code the COVID-19 diagnosis.
The provider also needs to document the
diagnosis as a “confirmed” diagnosis, as the
organization can’t code COVID-19 if the
provider documents the diagnosis as a
“probable” or “possible.”
3. Document and Appropriately Code the
COVID-19 Diagnosis

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
As of April 1, 2020, the correct diagnosis code
for COVID-19 was U07.1.
CMS indicates that the COVID-19 diagnosis
code can appear in any diagnosis field on the
claim (principal or secondary).
Health systems may benefit from having CDI
specialists review all inpatients on the COVID-
19 unit or all cases with positive lab results to
ensure the diagnosis documentation and
coding after discharge is appropriate.
3. Document and Appropriately Code the
COVID-19 Diagnosis

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
Some data platforms (e.g., the Health
Catalyst Data Operating System (DOS™))
allow facilities to send these specific cases
to a queue after discharge.
This way, health systems can validate that
the COVID-19 diagnosis is coded before
submitting the claim.
3. Document and Appropriately Code the
COVID-19 Diagnosis

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
Health systems can use a specialized tool,
such as the VitalWare® by Health Catalyst
VitalAuditor™, to assist with auditing. Such
tools filter accounts on several different
measures (e.g., by discharge date range or
accounts with a COVID-19 diagnosis).
3. Document and Appropriately Code the
COVID-19 Diagnosis

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How Health Systems Can Ensure the
COVID-19 Add-On Payment
Users can easily divide the accounts into
batches and assign them to multiple auditors.
The auditor can see how changes to the original
coding affects DRG weight and reimbursement.
The auditing tool can also run reports to show
auditor changes, DRG shifts, and financial
impact by DRG.
3. Document and Appropriately Code the
COVID-19 Diagnosis

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Ongoing Auditing for Appropriate Payment
Supports Healthcare Financial Recovery
Even with a solid front-end process for
meeting the COVID-19 add-on payment
requirements, organizations should continue
tracking claims until they receive payment.
Ongoing auditing will help health systems
identify denials and appeal within the
designated time frame, as well as identify
process improvement opportunities and
implement necessary changes quickly.

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Ongoing Auditing for Appropriate Payment
Supports Healthcare Financial Recovery
Organizations will benefit from staying up
to date with the rules and regulations
around coding and billing for COVID-19,
as compliance with these changes may
affect reimbursement.
A coding and regulatory information tool,
such as VitalWare by Health Catalyst
VitalKnowledge®, can assist organizations
by alerting them in real-time to the latest
changes to coding and billing rules and
regulations, ensuring ongoing auditing
practices for appropriate payment and
long-term financial recovery.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Link to original article for a more in-depth discussion.
Healthcare Financial Recovery: A Guide to the COVID-19 Add-On Payment
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Six Strategies to Navigate COVID-19 Financial Recovery for Health Systems
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A Five-Step Audit for Peak Charge Capture Performance
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Holly Rimmasch, Chief Clinical Officer; Ed Corbett, MD, Medical Officer

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Mikki Fazzio, RHIT, CCS, joined Health Catalyst in June 2021 as a principal content
integrity consultant. She is responsible for content integrity in the VitalWare® by Health
Catalyst VitalKnowledge™ system, the maintenance of VitalWare’s proprietary crosswalk
information (including CPT to ICD-10-PCS crosswalks, CPT/HCPCS to modifier
crosswalks, and CPT/HCPCS to revenue crosswalks), assisting with responding to
specialized client billing and coding questions, and providing educational webinars.
Fazzio has 15+ years of experience in the healthcare field. Prior to joining Health Catalyst, she was the
Director of Health Information Management and Clinical Documentation Integrity at Thibodaux Regional
Health System, where she led a team of hospital and professional coders, CDI specialists, EMR
specialists, transcriptionists, scanning technicians, and release of information technicians. Fazzio's main
responsibilities included overseeing the Clinical Documentation Integrity program, decreasing and
sustaining discharged-not-final-billed dollars for facility and professional coding, and case mix index
analysis. She has a degree in Psychology and Health Information Management, as well as certifications
as a Registered Health Information Technician and a Certified Coding Specialist through the American
Health Information Management Association.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Mikki Fazzio, RHIT, CCS

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Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement
company that helps healthcare organizations of all sizes improve clinical, financial, and operational
outcomes needed to improve population health and accountable care. Our proven enterprise data
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Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”