“Either hospitals have a code that is incompatible with the ICD-10 rules,” said Tom Nickels, executive vice president of the hospital association, referring to the diagnostic codes that hospitals use for billing, “or they are not paid even if the patient is clearly seeking treatment for Covid.
Harris Health, a public system of two Houston hospitals, did not bill the federal fund for 80% of the roughly 1,300 uninsured Covid-19 patients it had treated until mid-July because many of them also had other medical problems – most often sepsis, an overwhelming reaction to infection that results in loss of blood pressure and organ failure. In other cases, “an underlying health problem was the main reason for hospitalization, but was exacerbated by Covid-19 disease,” said Bryan McLeod, a spokesperson.
According to FAIR Health, a healthcare costs database, the total average cost of uninsured Covid patients requiring a hospital stay is $ 73,300, although they may be able to negotiate an amount inferior.
Repayments have varied considerably with little obvious explanation; Suppliers in New Jersey, for example, received $ 72 million in Covid treatment requests, while those in neighboring New York received half. Providers in hard-hit Texas and Florida, states that did not expand Medicaid to cover more poor adults, received $ 144 million and $ 53 million respectively for treatment.
“I just don’t know what’s going on,” said Jennifer Tolbert, director of public health reform at the Kaiser Family Foundation, who has taken a close look at the program and its claims database.
Despite its limitations, some hospital executives said they liked the program because it paid Medicare tariffs, which are considerably higher than those for Medicaid, the government health insurance program for the poor, or any normal funding that it does. they would receive for charitable care.
“It was a really progressive policy that really surprised us, frankly,” said Dr Shereef Elnahal, general manager of Newark University Hospital, NJ, which received $ 8.2 million for the treatment of 787 uninsured patients with Covid, about a third of its patients with coronavirus.