CMS Issues Call to Action Based on New Data Detailing COVID-19 Impacts on Medicare Beneficiaries

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

On June 22, 2020, CMS called for “a renewed national commitment to value-based care based on Medicare claims data that provides an early snapshot of the impact of the coronavirus disease 2019 (COVID-19) pandemic on the Medicare population.  The data shows that older Americans and those with chronic health conditions are at the highest risk for COVID-19 and confirms long-understood disparities in health outcomes for racial and ethnic minority groups and among low-income populations.”

“Now more than ever, it is clear that our fee-for-service system is insufficient for the most vulnerable Americans because it limits payment to what goes on inside a doctor’s office. The transition to a value-based system has never been so urgent. When implemented effectively, it encourages clinicians to care for the whole person and address the social risk factors that are so critical for our beneficiaries’ quality of life.” – CMS Administrator Seema Verma

The Preliminary Medicare COVID-19 Data Snapshot has a lot of information regarding Medicare Claims and Encounter Data: Services January 1 to May 16, 2020, Received by June 11, 2020.  Scroll down this webpage to view that information (you can also view the info on the 12-page Medicare COVID-19 Data Snapshot Fact Sheet).  I’m going to call out a few for your consideration and I encourage you to review all of the data.  Be sure to review the disclaimer verbiage for use of this data.  The data sources for the Snapshot are Medicare Fee-for-Service (FFS) claims data, Medicare Advantage (MA) encounter data, and Medicare enrollment information.

Medicare COVID-19 Case: A count of beneficiaries with a diagnosis of COVID-19 on a claim or encounter record for any healthcare setting (e.g., physician’s office, inpatient hospital, laboratory).

The following International Classification of Diseases (ICD), Tenth Revision (ICD-10), diagnosis codes were used to identify COVID-19 cases on claims and encounters:

  • B97.29 (other coronavirus as the cause of diseases classified elsewhere) – before April 1, 2020
  • U07.1 (2019 Novel Coronavirus, COVID-19) – from April 1, 2020 onward

Medicare COVID-19 Hospitalization: A count of beneficiaries with a diagnosis of COVID-19 on a claim or encounter record for an inpatient hospital setting. These beneficiaries are a subset of the Medicare COVID-19 Cases described above.

As of April 2020, over 62.3 million Americans are enrolled in Medicare:

  • 60% (37.5 million) in Medicare Fee-for-Service (FFS), also known as Original Medicare
  • 40% (24.8 million) in Medicare Advantage (MA) plans