COVID-19 Hospital Reimbursement Frequently Asked Questions February 2022

There has been a variety of hospital reimbursement questions about COVID-19 asked by policymakers and the public. These FAQs help to address many of those questions.

Q1. Every hospital patient is required to take a COVID-19 PCR test. Is that test free?
A1. Yes. Under the CARES Act, patients cannot be billed for PCR testing. There is no out-of-pocket cost for patients.

Q2. Are hospitals getting “bonus” payments for each positive COVID-19 diagnosis or COVID-19 hospital admission?
A2. No. In 2020, Section 3710 of the CARES Act implemented hospitals receive an enhanced payment from the Medicare program for treatment of Medicare patients with a positive COVID-19 test. The enhanced payment is only for Medicare patients.
The enhanced payment being made by the Medicare program for COVID-19 patients is intended to recognize the higher than usual cost of caring for COVID-19 patients, and the additional costs hospitals must absorb to care for underinsured and uninsured COVID-19 patients.
The enhanced payment is far from a “bonus”. Medicare covers approximately 85% of the cost of care for hospitalized patients. The enhanced payment may allow hospitals to break-even in providing care for COVID-19 patients.

Q3. Are hospitals receiving a “bonus” on the entire hospital bill for use of remdesivir under the Medicare program?
A3. No. Medicare created what is call an add-on payment for COVID-19 patients who are treated with additional resources (like convalescent plasma and remdesivir) if the cost of treatment exceeds the standard payment with the enhancement. This type of add-on payment also is in place for new technologies used that exceed the usual payments and result in clinical improvement for the patient.

Q4. Are hospitals receiving another, larger “bonus” payment if a COVID-19 patient is mechanically ventilated?
No. Nothing in the CARES Act, the Medicare program or private insurance provides for additional payment to providers for mechanically ventilating a patient. That treatment is considered a last resort for COVID-19 patients who cannot be treated with high-flow oxygen as they battle COVID-19.

Q5. Do hospitals receive a “bonus” if the cause of death on the death certificate is listed as COVID-19, even if the patient did not die directly of COVID-19?
A5. No. Hospitals have never received payment based on the death of a patient for any cause.

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