CMS Payment Adjustments for Medicare Providers

During the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) has adjusted certain payments to Medicare providers. Blue Cross and Blue Shield of Texas (BCBSTX) is applying these temporary adjustments to claims reimbursements, as appropriate and where consistent with network contracts, for Medicare Advantage providers.


What has changed?

Diagnosis Related Group (DRG) add-on payment: For discharges of members diagnosed with COVID-19, the weight of the assigned DRG has temporarily increased 20 percent. Providers should use the appropriate diagnosis code and date of discharge to identify members:

  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere) for discharges occurring on or after Jan. 27, 2020, and on or before March 31, 2020.
  • U07.1 (COVID-19) for discharges occurring on or after April 1, 2020, through the emergency period.

Medicare sequestration suspended: The Medicare sequester has been suspended between May 1, 2020, and Dec. 31, 2020. During this time, BCBSTX is suspending the 2% sequestration reduction in Medicare claims payments. This applies to Medicare providers who service Medicare Advantage members.


Questions?

Please call the number on members’ ID cards.


Resources



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