The following is a guest article by Susan Gatehouse, Founder & CEO, Axea Solutions.
Though the response has been swift, when the COVID-19 coronavirus first emerged, there were no specific codes or guidelines set and no process to document testing accurately. We now have designated diagnoses codes and guidance, but requirements around COVID-19 continue to remain fluid, as we see daily notices of changes on everything from new billing codes to updated reimbursement policies – Information keeps pouring in!
It has become a race to stay up-to-date for healthcare professionals on the latest changes and information related to COVID-19. It goes without saying, hospitals and healthcare facilities have made some pretty drastic adjustments to acclimate to the evolving situation and in an expedited fashion. It would be nice to know these changes and the current volatile environment were drawing to a close, but unfortunately, there is no end in sight just yet.
During this unusual and unprecedented time, misinformation can be dangerous. Information on coding, documentation, and claims processing continues to evolve, with shifting guidelines and new regulations introduced on an almost daily basis. Because of this constant flux, it is critical to stay up-to-date to ensure your teams are working with current, and accurate information related to COVID-19. Ensuring accurate, current information is communicated across necessary teams, and then transferring that information into procedures is required to mitigate future issues.
There is a multitude of resources providing updated information and guidance; it can be overwhelming keeping up with the changes introduced, often on a day-to-day basis. To help maneuver through the turns, we’ve created a comprehensive list of Coding, Telehealth, Billing, and other HIM resources. Along with our more comprehensive list, here is our Top-5 resource list of information required for efficient management and the most up-to-date detail and effective dates!
Top 5 Go-To List – Resources for Key Updates and Facts on COVID-19
# 1 – Coding and Diagnosis Guidelines
Initially, there was no way of pinpointing the COVID-19 pandemic condition in codes until we had a dedicated, specific code. Even with the implementation of dedicated codes, there is still confusion and many questions around how to code for COVID-19. Questions have arisen in areas such as the protocol around guidelines of coding a ‘presumptive positive’ as opposed to a ‘confirmed positive’; or, how to handle sepsis due to COVID-19.
These and other questions continue to emerge with each passing day. Accounting for COVID-19 coding accuracy, coupled with continuous training on guidelines is critical, and will not only help to cope with the current situation, but it will also provide a foundation for handling the unexpected of what the future may bring, post-pandemic
Check daily updates, the latest announcements and review official coding and reporting guidelines on ICD-10-CM on the CDC/NCHS website here:
# 2 – CPT Updates
Access the new Current Procedural Terminology (CPT®) codes explicitly created to help streamline the novel coronavirus testing currently available on the United States market. Current updates and revisions for COVID-19 can be accessed on the AMA site here:
# 3 – Medicare Coverage and Payment Related to COVID-19
The Centers for Medicare & Medicaid Services (CMS) have taken numerous additional actions to ensure healthcare facilities and clinical laboratories are prepared to respond to COVID-19. Be sure to educate teams on the details of coverage and payments for related services such as Diagnostic Tests, Inpatient Hospital Care Services, Inpatient Hospital Quarantines, as well as Telehealth and other Communication Based Technology Services.
Details on all related Medicare coverage can be found in this CMS COVID-19 Fact sheet:
# 4 – Telehealth and Virtual Services – Medicare Coverage and Payment
The Centers for Medicare & Medicaid Services (CMS) lifted Medicare restrictions on the use of telehealth and virtual services during the COVID-19 emergency. As a result of the current public health emergency waivers and modifications were authorized under Section 1135 of the Social Security Act (the Act).
Everything from Telehealth care provider information to the different types of virtual services available can is accessible from the CMS website, in the CMS Telemedicine Healthcare Provider Fact Sheet:
# 5 – Billing and Payments
In light of the CVOID-19 crisis, Medicare relaxed a lot of rules, regulations, and conditions, to provide more flexibility to physicians, hospitals, and mid-level providers. Certain details, such as different dates applying to different codes, have caused serious confusion. Without confirming proper billing procedures, future denials for COVID-19 are at risk. It’s essential to stay informed and take steps now to prepare staff for proper coding of claims as well as resubmission of claims. Access NUBC Guidance on Claims for COVID 19 Treatment here for all required details on coding claims:
Regularly reviewing official resources ensures teams stay up to date on the critical issues and provides needed guidance on how to manage the current situation, as well as navigate into the future. Understanding requirements and implementing changes as they occur is challenging but critical from a medical coding, billing, and reimbursement perspective.
The day will inevitably come in which we will be operating in a post-pandemic environment, but no one knows precisely what that will look like, or when exactly it will happen. Healthcare professionals must continue to monitor changes, with training on guidelines continually surveyed carefully. Maintaining accuracy and building on a sound foundation of accuracy and efficiency will help to navigate through this crisis, and be prepared for the aftermath.
You can access a comprehensive list of resources that includes information in multiple COVID-19 related areas for hospitals and healthcare professionals on the Axea Solutions website.
About Susan Gatehouse
Susan Gatehouse is the founder and Chief Executive Officer of Axea Solutions Inc. As a tenured industry expert with more than 20 years of experience in all aspects of the healthcare revenue cycle, her strategic leadership is the driving force that has propelled the success of the organization.
Clients rely on the vast experience of the Axea team, with documentation and coding quality, compliance, clean claims submission, and denials management to craft lasting solutions to their unique challenges. The Company’s holistic approach includes detailed assessments, innovative methodologies and services, and multifaceted education strategies designed to foster improved clinical documentation and coding accuracy, streamline patient financial workflow, and boost financial success within an array of healthcare settings. To learn more about Axea Solutions, visit the company website at www.axeasolutions.com or follow on LinkedIn or twitter for up to date industry information.