“Either hospitals code inconsistent with ICD-10 rules,” said Tom Nickels, an executive vice president of the hospital association, referring to the diagnostic codes that hospitals use for billing, “or they don’t get paid even though the patient is clearly getting treated for Covid.”
Harris Health, a two-hospital public system in Houston, did not bill the federal fund for 80 percent of the roughly 1,300 uninsured Covid-19 patients it had treated through mid-July because many of them also had other medical problems — most often, sepsis, an overwhelming reaction to infection that causes blood-pressure loss and organ failure. In other cases, “an underlying health condition was the primary reason for hospitalization, but was exacerbated by the Covid-19 disease,” Bryan McLeod, a spokesman, said.
Nationally, the total average charge for uninsured Covid- patients requiring a hospital stay is $73,300, according to FAIR Health, a health care cost database, although they may be able to negotiate a lower amount.
Reimbursements have varied widely with few obvious explanations; New Jersey providers, for example, have received $72 million in Covid treatment claims while those in neighboring New York have received half as much. Providers in hard-hit Texas and Florida, states that have not expanded Medicaid to cover more poor adults, have received $144 million and $53 million for treatment, respectively.
“It’s just not clear to me what’s going on,” said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation, who has looked closely at the program and its claims database.
Despite its limitations, some hospital executives said they liked the program because it paid Medicare rates, which are considerably higher than those for Medicaid, the government health insurance program for the poor, or any normal funding they would receive for charity care.
“This was a really progressive policy we were really surprised by, frankly,” said Dr. Shereef Elnahal, the chief executive of University Hospital in Newark, N.J., which has received $8.2 million for treating 787 uninsured patients with Covid, about a third of its coronavirus patients.