Impact of COVID-19 on Healthcare Revenue Cycle Management
As entire nations encourage their populations to stay inside to avoid COVID-19, healthcare providers are more active than ever in response to the outbreak of the novel coronavirus. This activity is having a significant impact on the healthcare revenue cycle and provider finances. The outbreak has been a major cause of concern for healthcare providers who are on the frontline of testing and treating infected individuals. Among their concerns is the impact COVID-19 will have on the healthcare revenue cycle and financial operations.
Healthcare providers are rapidly implementing emergency preparedness plans, seeking places to put overflow patients, acquiring diagnostic tests, identifying and protecting staff, and more. To help providers handle the new challenges, the government and payers are helping to alleviate the revenue cycle obstacles presented by COVID-19. Keeping the billing office running during an outbreak is key to keeping hospitals and practices open for infected individuals requiring care. But this can be a challenge, especially for smaller organizations with limited cash on hand to respond to COVID-19 demands.
CMS has been at the forefront of helping providers handle the medical billing and coding aspect of COVID-10 testing and treatment. The agency in first week of Mar’20 released two Healthcare Common Procedure Coding System (HCPCS) codes that laboratories can use to bill for certain COVID-19 diagnostic tests, including those developed in-house according to new FDA guidelines. The American Medical Association (AMA) also announced today that it is fast-tracking the development of a unique Current Procedural Terminology (CPT) code for reporting novel coronavirus testing.
Billing and Coding for COVID-19
CMS recently released guidance on billing and reimbursement for treating COVID-19. The agency reminded providers that Medicare will pay for evaluation and management (E/M) and other services furnished in a beneficiary’s home by a physician or non-physician practitioner. Medicare will also reimburse providers for many non-face-to-face services used to assess and manage a beneficiary’s condition, the agency stressed. For hospitals, Medicare will pay the diagnostic-related group (DRG) rate and any cost outliers for the entire stay if a beneficiary is a hospital inpatient for medically necessary care. This includes payment for when a patient needs to be isolated or quarantined in a private room. Hospitals almost at capacity during an emergency may also be able to add a remote location that provides inpatient services even in the absence of an 1135 waiver, CMS stated. To further support providers, the Trump administration is also reportedly weighing implementing a natural disaster program to pay hospitals and other providers for treating uninsured patients infected with COVID-19. The program typically pays providers about 110 percent of Medicare rates.
Collecting Patient Responsibility
Healthcare providers are already struggling to develop collection strategies in the era of high-deductible health plans and other cost-sharing arrangements. But putting these new strategies in use during an emergency can be nearly impossible. Payers are acknowledging the difficulties arising from patient financial responsibility and many are making it easier for patients to seek care and for providers to streamline the financial encounter. America’s Health Insurance Plans (AHIP) announced last week that it is implementing solutions to lowering out-of-pocket costs for people seeking testing for and treatment of COVID-19. One of those solutions is covering diagnostic testing when ordered by a physician. AHIP members vowed to “ease network, referral, and prior authorization requirements and/or waive patient cost-sharing” for physician-ordered COVID-19 testing. They will also work with providers to ensure effective treatment is available for those who are infected. This includes sharing information, mobilizing network providers, and encouraging the use of telehealth.
COVID-19 is putting a lot of demand on an overburdened healthcare system, overwhelming the capacity of hospitals, emergency departments, outpatient centers. This results in critical shortages of staff, space, and supplies, which can have a negative impact on patient outcomes. Allocating resources appropriately when demand starts to exceed those resources is critical to keeping operations running for patients who need care. For further details on coronavirus medical billing, stay connected with us. If you have any questions about coronavirus medical billing you can reach us at 888-552-1290 or write to us at info@e2eMedicalBilling.com