ConnectiCare will follow Medicare guidelines in the federal coronavirus (COVID-19) stimulus bill (known as the “CARES Act”) to:
- Add 20% to the COVID-19 inpatient reimbursement for both in-network and out-of-network care given to Medicare Advantage members.
- Temporarily suspend the 2% provider payment reduction fee known as “Medicare sequestration” from May 1, 2020 through Dec. 31, 2020.
This only applies to our members with Medicare Advantage plans.
Adding 20% to COVID-19 inpatient reimbursement
In accordance with the Centers for Medicare & Medicaid Services (CMS) methodology, ConnectiCare will add 20% to the MS-DRG-based inpatient reimbursement (operating component only) for patients who were discharged with a COVID-19 diagnosis after Jan. 27, 2020. ConnectiCare will identify and reprocess any claims that should have included the additional reimbursement. Providers do not need to resubmit the claims. Providers must follow the coding and billing requirements from CMS. This will apply to both in-network and out-of-network providers.
- For in-network providers, the increase will be applied, as appropriate, to payments to providers whose contracted reimbursement is based on the CMS inpatient prospective payment system.
- For out-of-network providers, the increase will be applied for Medicare Advantage members based on CMS requirements.
Temporary suspension of the Medicare sequestration fee
We will temporarily suspend the 2% Medicare sequestration fee for in-network providers based on the terms of your participation agreement with ConnectiCare. This temporary suspension applies to payments with dates of services or discharges from May 1, 2020 through Dec. 31, 2020.
While we believe the information in this communication is accurate as of the date published, it is subject to correction or change during the rapidly evolving response to the COVID-19 outbreak.
