3 Ways to Get Ahead of COVID-19 Coding and Billing Problems

Right now, hospitals and healthcare systems are facing tremendous disruption from the COVID-19 Public Health Emergency (PHE).  There are shortages affecting everything from capacity and available beds to personal protective equipment (PPE) and staff.  The overwhelming influx of coronavirus patients is pushing out elective procedures and routine care—normally the bread and butter of many specialties and healthcare facilities.

While the HHS/Centers for Medicare and Medicaid Services (CMS) and insurance payers are making every effort to reduce or eliminate barriers to testing and treatment for COVID-19-related patients, the process of documenting care and treatment, as well as coding and billing for that care continues.  Additionally, burdensome, care, and follow-up continue to be rendered for chronic patients and emergencies that also require administrative processing.

How to Stay Fluid 

Most states are beginning to ease stay-at-home orders through the end of May.  That means that many hospital and practice billing and business functions will continue to be processed remotely, or worse, be left unfinished and unfiled.  For economic viability, it’s imperative to implement a solution that keeps revenue flowing through these extremely uncertain times.

3 Ways to Stay Ahead of the Coding and Billing Curve

  1. Stay up to date on changes.  The World Health Organization (WHO), declaring this a public health emergency of international concern, created two highly unprecedented, off-cycle COVID-19 ICD-10-CM codes:

    • An emergency ICD-10 code of ‘U07.1 COVID-19, virus identified’    This new code should be used for COVID-19 cases that are confirmed by diagnosis by a provider, have documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result.  A presumptive positive test result means an individual has tested positive for the virus at a local or state level but has not yet been confirmed by the CDC (something that is no longer required).

      If “suspected”, “probable,” or “inconclusive” COVID-19 is documented, do not use U07.1.  Assign a code(s) explaining the reason for the encounter (such as fever) or Z20.828 Contact with and suspected exposure to other viral communicable diseases.

    • An emergency ICD-10 code of ‘U07.2 COVID-19, virus not identified’ is no longer being used as of the April 1, 2020 Addenda from the CDC.
    • Code U07.1 may be used for mortality coding as the cause of death.
    • In ICD-11, the code for the confirmed diagnosis of COVID-19 is RA01.0, and the code for the clinical diagnosis (suspected or probable) of COVID-19 is RA01.1.

    The American Medical Association (AMA) has also updated the CPT coding guidelines to reflect changes to E/M and telehealth visit requirements summarized here.

    The American Hospital Association (AHA) requested the CMS issue guidance on the use of the new ICD-10-CM diagnosis codes for DRG purposes, and that is summarized here.

  2. Remember, many waivers and emergency proclamations relate only to COVID-19 testing and treatment.  For instance, copays and prior authorizations are waived by insurance companies — but only for COVID-19 related care.  That means that care rendered for anything unrelated is still required to be authorized (if necessary), coded and billed according to contractual insurance obligations.Neglecting to meet those standards will result in denied claims and uncollected write-offs.
  3. Whether overwhelmed by the influx of patients or finding idle downtime, now is the time to seek coding and billing support from a third-party partner.  An outside team, like Infinx, can offer both coding and billing as scalable services to reduce the headache of finding temporary staff that requires training and assimilation.  Additionally, with today’s technology, partner support can be up and running lightning fast.

    Conversely, if COVID-19 is having less of an impact and care and treatment have slowed with social distancing and stay at home orders, now is the perfect time to enlist a partner in focused A/R reduction efforts.

While day-to-day activities have been drastically altered since the onset of the PHE, this will end at some point, and a more normal existence will resume.  When that happens, those who have been proactive with both coding and billing, as well as AR management, will find themselves well-positioned, and those who haven’t may be scrambling to catch up.

Contact Infinx today to learn more about quickly scaling to meet your emergent coding and billing support needs.

About the Author

Infinx
Infinx Healthcare provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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