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Claims with COVID diagnoses require positive test in chart
November 20, 2020

This article is for acute care hospitals caring for our Medicare Advantage members who are paid at the Medicare standard rate

In alignment with CMS and the CARES Act, relative weights for inpatient hospital claims for Medicare Advantage members diagnosed with COVID-19 are increased by 20 percent during the COVID-19 Public Health Emergency.

We would like to remind you that for dates of service on and after September 1, 2020, the patient’s medical record must include a positive COVID-19 laboratory test to qualify for this increase.

We may retroactively audit claims to ensure that Medicare Advantage claims with a COVID-19 diagnosis include a positive test.