Motorcycle Accident Victim Listed as COVID-19 Death, Is Someone Getting Paid?

July 17, 2020

By: Staff Report

TAMPA, Fla.- Fox 35’s Danielle Lama in Orlando, opened a can of worms on Florida’s COVID-19 data and reporting, by asking a simple question about two twenty-year-old COVID-19 deaths that were reported out of Orange County.

A 20-year-old person, who died in a motorcycle accident was added to Florida’s COVID-19 death count, according to a state health official, Lama uncovered on Friday.

Lama asked Orange County Health Officer, Dr. Raul Pino, whether two COVID-19 victims, who were in their 20s, had any underlying conditions.

Pino replied, “The first one didn’t have any. He died in a motorcycle accident.”

Lama, then asked Dr. Pino if the motorcycle accident victim’s death had been removed from the COVID-19 state data, his reply was even more shocking.

“I don’t think so. I have to double-check,” Pino said. “We were arguing, discussing, or trying to argue with the state. Not because of the numbers, it’s 100, it doesn’t make any difference if it’s 99, but the fact that the individual didn’t die from COVID-19, died in the crash. But you could actually argue that it could have been the COVID-19 that caused him to crash. I don’t know the conclusion of that one.”

One would think that it does make a difference.

Back in April, as COVID-19 was swallowing New York City and spreading across the globe, questions were raised in regards to increased payments to hospitals for COVID-19 treatment and deaths.

Senator Scott Jensen, R-Minn., a physician in Minnesota, was interviewed by “The Ingraham Angle”, Laura Ingraham on April 8 on Fox News and claimed hospitals get paid more if Medicare patients are listed as having COVID-19 and get 3-times as much money if they need a ventilator.

“How can anyone not believe that increasing the number of COVID-19 deaths may create an avenue for states to receive a larger portion of federal dollars. Already some states are complaining that they are not getting enough of the CARES Act dollars because they are having significantly more proportional COVID-19 deaths, ” Jensen said.

Jensen said, “Hospital administrators might well want to see COVID-19 attached to a discharge summary or a death certificate. Why? Because if it’s a straightforward, garden-variety pneumonia that a person is admitted to the hospital for – if they’re Medicare – typically, the diagnosis-related group lump sum payment would be $5,000. But if it’s COVID-19 pneumonia, then it’s $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000.”

Snopes weighed in on these payment claims as well, to conclude a mixed true/false from Jensen’s statements.

What’s True

It is plausible that Medicare is paying hospital fees for some COVID-19 cases in the range of the figures given by Dr. Scott Jensen, a Minnesota state senator, during a Fox News interview.

What’s False

However, Medicare says it does not make standard, one-size-fits-all payments to hospitals for patients admitted with COVID-19 diagnoses and placed on ventilators. The $13,000 and $39,000 figures appear to be based on generic industry estimates for admitting and treating patients with similar conditions.

Any way you shake it, even shaking into a mix of true/false, hospitals get paid more for COVID-19 illness, and death.

Factcheck.org also weighed in on this topic . Angelo Fichera interviewed Jensen said, “The figures cited by Jensen generally square with estimated Medicare payments for COVID-19 hospitalizations, based on average Medicare payments for patients with similar diagnoses.”

FactCheck reporter Angelo Fichera, who interviewed Jensen, noted, “Jensen said he did not think that hospitals were intentionally misclassifying cases for financial reasons. But that’s how his comments have been widely interpreted and paraded on social media.”

FactCheck’s conclusion? “Recent legislation pays hospitals higher Medicare rates for COVID-19 patients and treatment, but there is no evidence of fraudulent reporting.”

We wanted to read the language from the CARES act and Medicare/Medicaid. Below is directly from the Centers for Medicare and Medicaid Services (CMS), and dives into the 20% increase of payments for COVID-19 patients.

The Centers for Medicare & Medicaid Services (CMS) released new guidance implementing several provisions included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. These provisions include:

  • A Medicare add-on payment of 20% for both rural and urban inpatient hospital COVID-19 patients;
  • Waiver of the long-term care hospital (LTCH) site-neutral policy for COVID-19 patients;
  • Waiver of the LTCH “50% Rule” for COVID-19 patients; and
  • Waiver of the inpatient rehabilitation facility (IRF) “3-hour Rule” for COVID-19 patients.

HIGHLIGHTS OF THE GUIDANCE

Diagnosis-related Group (DRG) Add-on Payment 

The CARES Act provided for a 20% add-on to the inpatient prospective payment system (PPS) DRG rate for COVID-19 patients for the duration of the public health emergency. CMS states that it will identify discharges of an individual diagnosed with COVID-19 using the following ICD-10 diagnosis codes:

  • U07.1 (COVID-19) for discharges occurring on or after April 1, 2020
  • 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

Further coding guidance is available for discharges on or after April 1 and prior to April 1.

For discharges with the diagnosis codes above, CMS will apply an adjustment factor to increase the DRG weight by 20% when determining inpatient PPS operating payments. Inpatient PPS claims for COVID-19 discharges on or after Jan. 27 that are received by CMS before April 21 will be automatically reprocessed to reflect the payment increase. Claims received on or after April 21 will be processed reflective of the 20% increase.

LTCH Provisions

LTCH Site-neutral Payment Policy

As required by the CARES Act, CMS waives the LTCH site-neutral policy for admissions to LTCHs during the COVID-19 emergency. To implement this provision, the Medicare claims processing systems will pay all LTCH admissions during the emergency a standard LTCH PPS rate, instead of a site-neutral rate, effective with admissions occurring on or after Jan. 27, 2020. Claims for admissions on or after Jan. 27 that are received by CMS before April 21 will be automatically reprocessed to reflect the standard rate. Claims received on or after April 21 will be processed reflective of the standard rate.

LTCH 50% Rule

The CARES Act also waives the LTCH 50% Rule during the emergency. This policy requires that LTCHs, in order to keep their LTCH designation, limit their site-neutral cases to 50% or less of all patients. CMS specifies that when assessing 50% Rule compliance, all admissions during the emergency period will be counted in the numerator of the calculation.

IRF 3-hour Rule 

In alignment with the CARES Act, CMS waives the IRF 3-hour Rule during the COVID-19 emergency. This policy requires that IRF patients receive at least 15 hours of therapy per week. This waiver supersedes guidance provided by CMS in its March 31 interim final rule with comment, which implemented certain COVID-19 relief.

If you made it this far, you might as well read the CARES act provision SEC.4409, which details the federal payment structure for hospitals in both rural and urban areas, during the emergency period. We have linked to the CARES Act itself in these sections.

SEC. 4409. MEDICARE HOSPITAL INPATIENT PROSPECTIVE PAYMENT SYSTEM ADD-ON PAYMENT FOR COVID–19 PATIENTS DURING EMERGENCY PERIOD.

(a) In General.—Section 1886(d)(4)(C) of the Social Security Act (42 U.S.C. 1395ww(d)(4)(C)) is amended by adding at the end the following new clause:

“(iv)(I) For discharges occurring during the emergency period described in section 1135(g)(1)(B), in the case of a discharge that has a principal or secondary diagnosis of COVID–19, the Secretary shall increase the weighting factor for each diagnosis-related group (with such a principal or secondary diagnosis) by 15 percent.

“(II) Any adjustment under subclause (I) shall not be taken into account in applying budget neutrality under clause (iii).”.

(b) Implementation.—Notwithstanding any other provision of law, the Secretary may implement the amendment made by subsection (a) by program instruction or otherwise.SEC. 4410. REVISING PAYMENT RATES FOR DURABLE MEDICAL EQUIPMENT UNDER THE MEDICARE PROGRAM THROUGH DURATION OF EMERGENCY PERIOD.

(a) Rural And Noncontiguous Areas.—The Secretary of Health and Human Services shall implement section 414.210(g)(9)(iii) of title 42, Code of Federal Regulations (or any successor regulation), to apply the transition rule described in such section to all applicable items and services furnished in rural areas and noncontiguous areas (as such terms are defined for purposes of such section) as planned through December 31, 2020, and through the duration of the emergency period described in section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)), if longer.

(b) Areas Other Than Rural And Noncontiguous Areas.—With respect to items and services furnished on or after the date that is 30 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall apply section 414.210(g)(9)(iv) of title 42, Code of Federal Regulations (or any successor regulation), as if the reference to “dates of service from June 1, 2018 through December 31, 2020, based on the fee schedule amount for the area is equal to 100 percent of the adjusted payment amount established under this section” were instead a reference to “dates of service from March 6, 2020, through the remainder of the duration of the emergency period described in section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)), based on the fee schedule amount for the area is equal to 75 percent of the adjusted payment amount established under this section and 25 percent of the unadjusted fee schedule amount”.

We have reached out to the Florida Department of Health with some questions regarding the death counts, hospitalizations for COVID-19, and underlying conditions listed in the state data, and will file a report when we have answers.

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