4 Tips for Physician Billing Services as COVID Evolves

While COVID-19 “changed everything”, the change hasn’t stopped. Physicians will find that, even as things are settling down, they will need to adapt — adjusting how they approach their billing to stay flexible and on top of shifts that impact their groups and practices. 

One of the most important and effective ways to do that is to adjust physician billing service tactics to react to pandemic changes. Here are a few best practices you or your outsource partner should focus on over time.

As the pandemic continues, many organizations and companies will be compiling resources to help you and your team optimize your billing and keep revenues healthy. For example, the American College of Physicians (ACP) provides a coding and billing resource page [1]. It includes information on:

• Telehealth guidance and resources, to help physicians bill for tech-enabled care like telephone visits, online digital E&M, video visits, and remote patient monitoring
• Vaccines, including payment rates, Medicare at-home reimbursement, and their efforts to advocate CMS and private payers to provide physicians with reimbursement for vaccine counseling to patients who have received the vaccine from any setting (this includes pharmacies and mass vaccination sites)
• ICD-10 codes with regular updates related to the pandemic, including sequencing advice
• CPT and lab codes that are specific to COVID-19 testing, along with a summary of Medicare payments for lab testing by location and type of test
• Coding scenarios, including coding guidance related specifically to COVID-19 testing, such as how to code when a patient comes to an office for an E/M visit and is tested for the COVID-19 virus. 

Another resource to stay on top of in your physician billing services is the Health Resources & Services Administration (HRSA), which includes regular updates like information for providers and patients who want to learn more about their COVID-19 uninsured program, Spanish versions, webcasts, and detailed reimbursement information [2].

The commercial payer landscape is particularly difficult to navigate in terms of physician billing services. Each payer has its own requirements, and the implementation of legislation like the CARES Act further complicates your work. Still, it is possible to improve your reimbursement results from payers like these if you keep a few things in mind [3]. 

• While payers must cover COVID-19 testing without cost sharing, you and your billing staff or outsource partner are responsible for knowing what testing includes and how payers are required to pay. 
• If you’ve received payments under the Provider Relief Fund created by the CARES Act, you have to abide by strict conditions, like not balance billing your COVID-19 patients. 
• You will be balancing the adoption of new innovative strategies to make sure you’re paid for telehealth services while staying within payer policies and law. 
• You can expect to see future changes to commercial payer policies. This is on top of changes that are deemed necessary by federal, state and local agencies or lawmakers. 

For example, UnitedHealthcare offers its COVID-19 Billing Guide. The guide covers topics including claim submission and billing, vaccine billing, treatment, medical supply codes, testing and testing-related services, and urgent care testing and vaccine administration — all of which billing staff will have to keep up with [4].

Perhaps the most volatile factor in COVID-19 reimbursement, telehealth will be especially challenging to keep up with. 

For example, many states that you operate in are likely taking action to expand telehealth and telemedicine access through the pandemic and into the future. This includes efforts to enhance private insurance coverage and reviewing how to regulate telemedicine and telehealth services after the pandemic. According to The Commonwealth Fund, 22 states changed their policies or laws to support enhanced insurance coverage of telemedicine, focusing on audio-only services, waiving cost sharing/requiring cost sharing no higher than in-person services, and requiring reimbursement parity between in-person services and telemedicine [5]. 

But as the pandemic continues on, many of these emergency orders and efforts are expiring, complicating reimbursement and requirements for out-of-state professional licensing. 

Get a Grasp on Coding Scenarios

Keeping your physician billing services up to date with the range of potential coding scenarios can be especially complex. For example, take a look at the American Academy of Family Physician (AAFP) guidance on coding scenarios for telehealth visits during the pandemic. You’ll find recommendations on established patients, new patients using telehealth for non-COVID care, and more. Each situation includes payer-specific guidance for insurance companies including Humana, Cigna, Aetna, Medicare and more [6]. The American Medical Association (AMA) offers similar support for coding scenarios, such as cases where a patient receives a telehealth visit to address COVID-19 but is sent to an unaffiliated testing site, or they’re ordered by a physician to receive remote physiologic monitoring after quarantining at home after a COVID-19 diagnosis [7]. 

All of these complexities in physician billing services can be a burden on you and your staff in the middle of an ongoing pandemic. Now is an excellent time to update your telehealth and telemedicine billing strategy, adjust your KPIs, and consider outsourcing physician billing services to a partner who stays on top of all of the changes mentioned above. To learn more about your options, start here.