Stethoscope laying on top of ipad that says COVID-19.

In a recent article by RevCycleIntelligence.com, CMS has finalized a proposal that makes reporting COVID-19 data a condition of participation (CoP). This highlights the importance CMS relates to receiving this data to better understand the progress of the virus.

New guidance from CMS shares how the agency plans to implement a recent interim final rule that makes COVID-19 data reporting a CoP in Medicare for hospitals.

The guidance released earlier this week states that hospitals will be terminated from Medicare for failing to report on the over 30 metrics CMS is requiring daily during the COVID-19 public health emergency. The metrics include daily COVID-19 admissions, including those involving ventilated patients, COVID-19 deaths, and other information about hospital utilization related to the virus.

Hospitals will also have to report on supply-related metrics weekly and new metrics on flu cases, which are currently optional but will be mandatory next month.

However, the guidance did reduce reporting on remdesivir and staffing-related data starting on November 1, 2020, and states that psychiatric and rehabilitation hospitals will only have to report data once per week.

Hospitals that are not complying with COVID-19 data reporting requirements will be sent a notification from CMS starting October 7, 2020. The hospitals will have three weeks to resolve any gaps in compliance, guidance states. After that, CMS will receive a second advisory notice to hospitals that continue to not send data daily.

Following two advisory notices, CMS will issue enforcement notices to hospitals that continually fail to submit required data daily starting three weeks after the second advisory notice. The guidance states that providers will have one calendar week to demonstrate compliance.

CMS will send three enforcement notices before notifying hospitals that it will terminate their participation in Medicare. The fourth and final enforcement notice will contain a notice of termination that will become effective within 30 days unless the hospital complies with COVID-19 data reporting requirements in updated CoP.

In total, hospitals have 14 weeks to comply with the Medicare CoP before being terminated from federal healthcare programs. Termination would mean providers would not receive reimbursement for treating Medicare and Medicaid beneficiaries.

However, the interpretative guidance notes that hospitals will only receive advisory notices until November 18, 2020. After that, non-compliance with the new CoP will result in enforcement notices.

CMS plans to implement the enforcement process throughout the COVID-19 public health emergency.

The American Hospital Association (AHA) called the enforcement process in the latest guidance document “an overly heavy-handed approach that could jeopardize access to hospital care for all Americans.” The group reported that, through collaboration between hospitals and federal agencies, 94 percent of hospitals are submitting data.

On a conference call with reporters, Deborah L. Birx, MD, the White House’s Coronavirus Response Coordinator, emphasized that the data required from hospitals is “critical” and will be used “to understand where this epidemic is, how it’s moving through different populations, and ensuring that we’re meeting the needs of specific hospitals and communities.”

An internal CDC presentation obtained by NPR, however, showed that for the week of Sept. 14, only about a quarter of hospitals reported all the required data points every day.

There has been some pushback by the hospital professional associations regarding this latest data request. We understand the constant changing burden of data requests by CMS and its administrative burden to hospitals. However, we hope both sides can work together to gather this important information to better understand the progress of the virus.