As we all navigate uncharted waters with this unprecedented pandemic, we are working to identify best practices and considerations specific to the revenue cycle. While we continue to see variation around billing guidelines from payers, the following list provides much needed guidance on items for consideration.
As billing and reimbursement guidelines evolve, many organizations are holding their COVID-related charges. The below tips can help with patient, diagnosis and charge identification.
- Identifying patients – Identifying patients with a suspected or confirmed COVID-19 diagnosis is critical to your workflows, billing edits, and potential reimbursement down the road. Patient FYIs are a great way to track and report on affected patients. The FYIs may be added manually or automatically upon ordering a COVID-19 lab test.
- Charge review edits – Billing guidelines are still fluid, and many payers are not ready to accept COVID-related charges. Build out edits for any of your COVID-related testing and treatment charges to hold in charge review work queues until guidance is confirmed and charges can be released.
- Vendor Support – Many vendors are releasing specialized content to aid with diagnosis capture.
- IMO (Intelligent Medical Objects) has released 15 new descriptors to help clinicians more accurately record diagnoses related to COVID-19. As part of their March 26 release, they increased that to 136 terms and created COVID-19 precision sets, which are free to all customers.
- SMART® (coding editing software) has already released COVID-19 custom flags, which will integrate with the new CDC COVID-19 diagnosis code U07.1 when it becomes effective 4/1/20. COVID-19 standard flags will be available 4/15/20. The CPT/HCPCS codes for telehealth and e-visits, along with virtual check-in’s will also be available for usage.
Many healthcare organizations are turning to telehealth to deliver much-needed care to patients who should not be seen in the clinic, whether it is related to a respiratory illness or routine care. Telehealth encompasses video visits, telephone visits, and e-visits. Check out our recent compilation of telehealth platforms.
- Scheduling (Existing Visits) – Build unique visit types for your telephone and video visits. Ask providers to review their schedules to determine who needs to be seen in clinic, who can wait until a future date, and who can be treated via telehealth. Schedulers can then contact patients with current visits that will be converted to telehealth to obtain consent and change the visit type on the appointment.
- Scheduling (New Visits) – Develop a workflow with clinical staff to triage new patients with symptoms to determine the best course of action. If the clinical team determines the patient would be a fit for telehealth services, schedule a new appointment using the appropriate telehealth visit type.
- Template Build - Consider building a telehealth block to designate certain slots on the provider’s schedule for telehealth or provide the patient with a call window.
- Phone Caller ID – If employees will be working from home, consider the phone number which displays to the patient. Ideally you would leverage soft phones or something similar which would display the clinic phone number. If that is not available, Doximity may be used by providers when making outbound calls from their home. This lets providers call from their personal phones but displays the clinic phone number. Video visit platforms typically send a hyperlink to patients, avoiding the issue of caller ID.
- Registration – Complete pre-registration activities at the time of scheduling to streamline the process and increase your chances of getting a hold of the patient. This can be done in a combined scheduling and registration workflow or through warm transfer to Registration.
- Check-in – Telehealth visits may not start at the exact scheduled time. Consider checking in all telehealth appointments at the beginning of the day and having providers send messages back to Registration to cancel the check-in if they are unable to reach the patient.
- Consent – Many payers require patient consent for telehealth services. The approach varies by organization, but you may consider a new consent document with a ‘verbal agreement’ document status, electronic documents built into eCheck-in workflows, mailing paper copies for signature, or SmartPhrases in the provider’s note to capture consent.
- Time Spent with Patient – Some payers are requiring time-based codes for telehealth services. Work with your clinical teams to get a new component for time entry added to your visit navigators. Providers should document the time spent with the patient on the phone or video.
- Charge review edits – Similar to the COVID-related charges, you may want to consider charge review edits for telehealth services until billing guidelines are clear. You may choose one code such as the G2012 to drive the edit or catch all charges with a defined modifier such as GT, GZ or 95.
- Claims logic – Use claims logic to make sure you are getting the correct place of service (POS) added to your claims. Drive logic off of certain CPT codes or the presence of certain modifiers.
Due to the variation in payer requirements, we are not able to advise on specific codes. Rather, we are providing a framework to help build your approach to billing COVID and telehealth-related services.
- Payer Billing Requirements Grid – Create a grid to document all your payer requirements in one place. Share this grid with your clinical leaders and your coding team. The grid should contain at a minimum: billing codes, definitions, provider types, place of service, and modifier requirements by payer. It is also helpful to link to external references.
- Patient Responsibility – Develop policies and communication tools around patient responsibility during this time. Will you wave patient cost-sharing for certain services? Will you write off services not covered by insurance? Review your bad debt and collections policies. Consider holding bad debt transfers and outbound collections calls at this time. Create patient-facing communications to better serve your patients and answer questions they may have about the financial impact of this pandemic.
- Financial Assistance – If you will be extending your financial assistance program to patients who wouldn’t otherwise qualify, consider building out a new financial assistance program in your EHR to separate those expenses. Additionally, if a patient’s assistance tier is not eligible for review during a set timeframe, consider lifting these restrictions to allow people to re-apply for aid.
- Adjustment Codes – Build out new adjustment codes to track write-offs related to the COVID-19 pandemic. Use reports to assess the overall cost to the organization for potential aid down the road.
- Federally Qualified Health Centers (FQHCs) – FQHCs may not be covered by the legislation coming out at the federal level. Work within your health center networks to lobby your state programs for necessary benefits and aid during this time.
While this list is not comprehensive, it provides a framework to augment efforts already in progress. If you have questions, please contact Rebecca Haymaker at The Wilshire Group – email@example.com. Whether or not you are a current client, we have experts available to assist your team with COVID-19 response efforts and questions. Thank you for all of the work you are doing to mobilize your teams and take care of patients.