Quote from: franky1 on April 29, 2020, 09:17:27 AM

but the bit your missing is fact checkers and people currently in the finance system of hospitals have been quoted as saying that hospitals dont get a 3x payment for just writing covid19 on a discharge form
its also said that its not a simple one lump sum one size fits all payment

Hospitals can get 3x payment if a covid-19 diagnosis changes the surgical procedure payment bundling from regular treatment to treatment "with complications." This type of reimbursement manipulation has nothing to do with extra services or equipment and everything to do with diagnosis.

Hospital payments are made according to what are called Diagnostic Related Groups (DRGs). For example, treatment of a hospital stay for lung infection is billed by line item:

- type of hospital room used
- drugs administered
- medical supplies
- procedures performed by doctors, nurses, anesthesiologists, radiologists, etc.

The claim is sent to the insurance company which then uses computer software to bundle all the charges together to assign it a DRG to determine the payout. The software determines the patient was treated for a respiratory infection, which falls into one of these 3 DRGs (I made up the reimbursement figures but the DRG codes are real):

DRG 177 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC - $15,000
DRG 178 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC - $10,000
DRG 179 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC - $5,000

MCC = major complications
CC = complications

The software then looks at the diagnosis code(s) being put on the claim to determine which of the 3 codes to use. If pneumonia was the primary diagnosis, the software might assign the claim DRG 179 and the hospital will be reimbursed $5,000. If covid-19 was the primary diagnosis, the software might assign the claim DRG 177 and the hospital will be reimbursed $15,000.

So a difference of $10,000 is a great incentive for a hospital to potentially forge a fictitious diagnosis on a claim. Especially if a coder / medical biller employed by the hospital receives a cut from each successfully reimbursed claim. Even without this incentive, its easy to see why this is regularly taken advantage of by some of the more greedy hospitals, as they are capitalist enterprises by nature and looking to exploit every dollar they can out of a potentially broken / under-regulated system.

This behavior was already happening well before the coronavirus. There's no reason to think it isn't happening now.

Also, there are no "fact checkers" in the financial system of hospitals. There's very little oversight by the insurance companies themselves. They simply pass on the inflated costs to their customers.