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CMS PAYMENT ADJUSTMENTS FOR MEDICARE PROVIDERS

July 7, 2020

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 Oklahoma (BCBSOK) 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, BCBSOK 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.


CMS RESOURCES

 * CMS Current Emergencies and News Alerts

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