Big Al 1992 said:

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This article says average cost a Covid19 patient is $73K yet gets reimbursed at about $33k. That's not sustainable.

https://revcycleintelligence.com/news/how-much-will-the-covid-19-pandemic-cost-hospitals

Yet it sounds like the first wave of funds was a one size fit all - hard hit areas averaged only $12K per patient while other states averaged $300K.
https://khn.org/news/the-covid-19-bailout-thats-left-every-hospital-unhappy-in-its-own-way/

Are any hospitals making money? Especially when elective surgeries haven't been allowed. So many are furloughing and reducing staff - what is the answer?

Yet some say hospitals are coding everything as Covid19 to get more reimbursement per patient. I don't buy this and would think you can't just make up codes without a confirmed case. These patients would cost more - more CT scans, Xrays, PPE, staff. How does this all shake out?

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You cannot just slap a diagnosis code on a claim. You have to have proof of services rendered and backing for doing them. Payers frequently ask for medical records and do post payment audits. I know right now most payers are waving a lot of the record requests to get payments to hospitals quicker but they are also stating they will be doing post payment audits. I can almost guarantee Medicare will be doing audits on these payments and if they find a hospital using these codes for additional reimbursement they will hammer them. Medicare audits can already be pretty intense and I can almost guarantee they will be even more focused on these payments. Any hospital billing fraudulently would get hit hard.

I am in Hospital Revenue cycle and I know for a fact we are not putting Covid diagnosis codes or CPT codes unless the patient received services for it. Coders WGO actually review and code the claims could lose their licenses should they allow a claim to go out. Now there will be a greater percentage of patients with the virus in our billing but that is due to elective procedures being completely cancelled. Thankfully we are going to begin doing some elective procedures this week in Texas.

Non-surgical care(medical) has been under-reimbursed for a long time. COVID-19 admissions are high utilization medical admits.

I had a 15 paragraph rant ready to go on Medicare reimbursement but I've decided I've been too pissy lately on here.

Needless to say, the way healthcare providers / systems are reimbursed by CMS makes no sense. Even people who think they want "Medicare for all" have no idea what that entails for quality of care and timeliness of service.

Great info and insight. And debunks some of the gross misinformation and conspiracy theories that are floating around.

Moxley said:

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I had a 15 paragraph rant ready to go on Medicare reimbursement but I've decided I've been to pissy lately on here.

Needless to say, the way healthcare providers / systems are reimbursed by CMS makes no sense. Even people who think they want "Medicare for all" have no idea what that entails for quality of care and timeliness of service.

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My hospital is at 35% volume or less. Critical care pts are a loss leader for hospitals. Billions $ lost nationwide during this.