Due to COVID-19 outbreak, from continual updates to ICD-10, CPT and lab codes and special modifiers to telehealth expansion, the healthcare industry has had to deal with dramatic changes. Medical billing & coding serviceproviders require to continuous implementation of new strategies to manage revenue cycle, including documentation and billing for new reimbursement policies.
Here in below are the major healthcare revenue cycle management challenges created by the COVID-19 pandemic:
COVID-19 Billing and Coding:
As physicians focused their efforts on diagnosing and treating patients with COVID-19 symptoms and infection, they also have to deal with new codes and billing guidelines to report their services.
New ICD-10 Codes:
Initiated with the ICD 10 emergency code 1–2019-nCoV acute respiratory disease, effective from April 1, 2020, the Centers for Disease Control and Prevention (CDC) required providers to exposure to COVID-19 using code Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure, but ruled out after evaluation).
Effective from January 1, 2021, there are six new diagnosis codes for COVID-19. U07.1 for primary diagnosis, followed by appropriate codes for associated manifestations, as, J12.82 (Pneumonia due to coronavirus disease 2019). Appropriate codes have to be used to report signs and symptoms, e.g., R05 (cough).
There is separate COVID-19 diagnostic coding guideline for pregnant patients.
CMS has also introduced 21 new ICD-10-PCS codes for the vaccination and treatment of coronavirus.
New CPT Codes:
There are new CPT and HCPCS codes introduced specific to COVID-19 testing. CPT codes are also introduced to report coronavirus vaccine and administration codes for each vaccine.
CPT code 87635, effective from March 13, 2020, introduced for reporting infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique.
CPT code 86413 is introduced to report quantitative antibody detection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
CPT Code 99072 is introduced to report additional practice expenses incurred during a Public Health Emergency, including supplies and additional clinical staff time.
The main challenge is that billing processes for state Medicaid programs and private payers differ. Billers and coders need to communicate with payers for guidelines on submission of claims for the COVID-19 vaccine and administration.
Reporting Telemedicine Services:
Due to COVID-19 pandemic, telemedicine emerged as blessing for care of patients who have contracted the virus. The Centers for Medicare & Medicaid Services (CMS) issued multiple waivers and granted payment parity between telehealth and in-person clinical care for Medicare. Private insurance companies also followed in the transition to telehealth options during COVID-19 pandemic. However, providers had to deal with interstate regulatory issues that may vary by state. Though payers supported the transition to virtual care, as revenue cycle intelligence notes, coders and billers should identify how to document and bill for the new services amid frequent policy and regulation changes.
Rising Claim Denials:
As laid down by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, private health plans are required to cover COVID-19-related diagnostics and care (“qualifying coronavirus preventive service”) without co-pays, deductibles, and claim denials.
Unfortunately, medical billing provisions in the Act led to an increase in mispayments and claims denials. Introduction of new codes for COVID-19-related services, changing payer rules, including for telehealth, and problems tracking varying payer requirements have complicated claim processing.
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