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July 14, 2020

Health Law Daily

For COVID-19 Health Care Services, Private Payers Pay More Than Twice The Medicare Reimbursement Rate, Brief Demonstrates

  • July 14, 2020

HealthPayerIntelligence (7/13, Waddill) reports, “Private payers are paying far more for coronavirus-related healthcare services than Medicare, a recent Kaiser Family Foundation brief discovered.” The brief explained, “Private insurance payments for inpatient services vary based on several factors, most notably hospitals’ market power relative to that of insurers. In contrast, reimbursements in traditional (fee-for-service) Medicare depend on a set of federal policies and formulas.” The researchers examined “three COVID-related categories of respiratory diagnoses: respiratory condition with a ventilator for more than 96 hours, respiratory condition with a ventilator for less than or equal to 96 hours, and respiratory infections,” and found that “in every case, private payers were paying more than double the Medicare reimbursement rate.”