its about costs of actual care
just writing covid suspected but without a test does not earn a hospital more
yes doctors can run multiple tests like swabs xrays ct scans blood draws and other tests including a load of non essential tests. but if the death certificate does not match the test results. they will be reprimanded and the hospital would get fined by the insurer
in short. hospitals get paid for the TREATMENTS they give patients. not due to what they scribble randomly on a death certificate
I worked in health insurance for a number of years and I'm sure hospitals are motivated to code claims using the covid-19 diagnosis. This makes complete sense:
"Hospital administrators might well want to see COVID-19 attached to a discharge summary or a death certificate. Why? Because if it's a straightforward, garden-variety pneumonia that a person is admitted to the hospital for if they're Medicare typically, the diagnosis-related group lump sum payment would be $5,000. But if it's COVID-19 pneumonia, then it's $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000."
In theory, reimbursement is supposed to be proportional to the costs of care, but quite often it isn't. When a hospital can stick a diagnosis code on a claim that increases reimbursement from medicare (or whoever) by 3 fold, they will absolutely do it if they think they can get away with it. If a death certificate lists covid-19 on it then that 100% backs their claim if they should happen to get audited.
This is one of the many reasons why American health insurance is so fucked up.