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CMS Payment Adjustments for Medicare and MMAI Providers During Public Health Emergency

Posted May 21, 2021

On June 22, 2020, we mentioned that 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 Illinois (BCBSIL) is applying these temporary adjustments to claims reimbursements, as appropriate and where consistent with network contracts, for Medicare Advantage and Medicare-Medicaid Alignment Initiative (MMAI) providers. This includes providers who provide care and services to our members with any of the following plans:

  • Blue Cross Medicare Advantage (HMO)SM
  • Blue Cross Medicare Advantage (PPO)SM
  • Blue Cross Medicare Advantage (HMO-POS)SM
  • Blue Cross Group Medicare Advantage (PPO)SM
  • Blue Cross Group Medicare Advantage Open Access (PPO)SM
  • Blue Cross Community MMAI (Medicare-Medicaid Plan)SM

Diagnosis Related Group (DRG) Add-on Payment
For discharges of Medicare Advantage and MMAI 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) is for discharges occurring on or after Jan. 27, 2020, and on or before March 31, 2020.
  • U07.1 (COVID-19) is for discharges occurring on or after April 1, 2020, through the emergency period.

Medicare Sequestration Suspended Through Dec. 31, 2021
The Medicare sequester suspension period has been extended  through Dec. 31, 2021 (previously suspended through March 31, 2021). During this time, BCBSIL is suspending the 2% sequestration reduction in Medicare claims payments. This applies to Medicare providers who provide care and services to our Medicare Advantage and MMAI members.

Questions?
Call the number on the BCBSIL member ID card.

CMS Resources
Refer to the CMS website for Current Emergencies  and News Alerts .