How Medical Billing Services Are Changing in a Pandemic

Covid-19 has changed medical billing services. Healthcare providers around the country have been forced to rethink the most basic elements of their billing and coding. This has included everything from how to address new and emerging codes to how to keep their workers safe while still keeping medical coding and billing processes flowing.

While the pandemic is still developing, there are a few points that healthcare providers should consider to build an approach to medical billing and coding that will carry them through the pandemic and beyond. 

Healthcare providers around the country moved early to shift billing and coding functions to a work-from-home scenario. At the time, it wasn’t certain whether this was for the long-term or just temporary, but many organizations are settling into the idea of having billing and coding performed remotely to keep workers safe and slow the spread of the virus.

As more organizations are looking at a long-term, and possibly permanent shift of medical billing services to workers’ homes, there are a few best practices to keep in mind [1]. 

• Make sure workers have or are provided with the equipment they need, including a computer, printer, locking file cabinet, and paper shredder.
• Have a set policy that details requirements for eligibility to work from home. (Have both the employee and their supervisor or manager sign the agreement.) 
• Encourage coders to keep a productive and secure work environment by having a defined room, or at least workspace dedicated to billing and coding. 
• Communicate work hours clearly so that employees know the times they can and should be working remotely to avoid confusion around overtime, flextime, and split shifts. 
• Prioritize security by making sure employees understand and have the equipment necessary to maintain HIPAA compliance at home and that any technology they’re working on is properly secured with encryption software and other precautions. 
• Discuss logistics like communication methods, workflows, applications, and platforms needed to provide medical billing services.
• Regularly check in with staff to check on work completion, timelines, and to evaluate the state of relationships. 

While HIPAA penalties around telehealth communications have been temporarily suspended, many organizations will find it useful to take extra steps to ensure compliance. These include setting up VPNs and notifying staff that phishing attempts are expected to increase. 

Doing these things will help ensure that the shift to working from home is as smooth as possible while keeping billing processes flowing efficiently and securely. 

Keep in mind that with everything changing, codes are changing too. COVID-19 has brought the challenge of new codes and new ways of delivering services. 

For example, the American Medical Association (AMA) has updated CPT code sets to include two code additions (code 99072 for safety protocols and 86413 for lab tests) used to report medical services used in the response to the pandemic. Outpatient visits, additionally, also require special documentation that use visit type and time spent. 

Telehealth & Telemedicine

The federal government has implemented policy changes expanding Medicare coverage for telehealth during the pandemic. These include no geographic restrictions, an expansion of provider eligibility, more discretion in patient cost-sharing, and more freedom in modality. These changes directly impact how medical billing services function. 

Telehealth visits are now paid at the same fee-for-service rates as in-person visits. Additionally, for claims for services delivered from March 1, 2020 throughout the COVID-19 Public Health Emergency, billers must include place of services equal to what it would have been if the service had been furnished in person, and modifier 95 should be used to indicate the service was administered via telehealth. 

Other changes, like the expansion of the hospital at home, have been made to slow the spread of the disease by keeping patients who can stay at home away from the hospital. In terms of billing, hospitals can be reimbursed at a “site-neutral” rate for “hospital therapeutic services that are covered under 42 CR 410.27 if provided by hospital clinical staff. 

Rethink Surprise Billing

While many of the changes around COVID-19 have impacted emerging situations, some reach back and affect historic practices. For example, “surprise billing” has been up in the air since the pandemic hit. 

Hospitals could be banned from balance billing COVID-19 patients, but this perspective from HHS considers every patient a possible COVID-19 case. Individual states like Connecticut are taking action to protect both patients and health systems, and some believe that these changes could mean an end to surprise billing forever. 

Healthcare providers will need to watch coming changes in the pandemic closely to ensure that their medical billing services practices keep up with their needs. As billing becomes more complex and more changes continue to emerge, expect outsourcing services to a partner dedicated to keeping track of industry changes to become a more viable option for many hospitals, health systems, and long-term care providers.