COVID-19 “changed everything”, and that should probably include your stance on whether you should outsource medical billing.
Why is that? It’s because the changes that the pandemic brought with it impact much more than the clinical side of healthcare. Your organization has a history of strategies, processes, and technical approaches that have possibly served you well in the years before COVID-19, but as with so many things in healthcare, the implications will run deeper than patient outcomes. This means that those same processes won’t get you the same results in the coming years. It also means that any weaknesses in your billing strategy will be amplified through decreasing revenue, reduced efficiency, and greater strain on your staff.
Now is the time to build a deeper understanding of the challenges that have emerged as a result of COVID-19 and get started on shifting your approach to outsourcing medical billing.
What You Need to Know About COVID-19 to Outsource Medical Billing
Before you completely rethink your stance on outsourcing, let’s look at some of the changes that COVID-19 has brought to medical billing and coding [1].
ICD-10-CM
To help capture information around COVID-19 diagnoses on claims and surveillance data, the Centers for Disease Control (CDC) added the new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) emergency code created by the World Health Organization (WHO). The agency also issued official guidance specifying that the code (U07.1, 2019-nCoV acute respiratory disease) should only be used to document confirmed cases according to the documentation of a positive COVID-19 result or presumptive positive COVID-19 result. This guidance also applies to asymptomatic patients who test positive for the virus. But there is an exception. The confirmation doesn’t require documentation of the test performed, allowing provider documentation to be sufficient. Suspected, probable, inconclusive, or possible cases of COVID-19 shouldn’t be assigned code U07.1, with providers instead assigning codes explaining the reason for the encounter.
But this of course is just the beginning. As we learn more about the disease, coding will evolve, with new coding and billing guidelines likely to appear.
A Shift in CPT and HCPCS Coding
CPT codes haven’t been exempt from COVID-related changes, with the American Medical Association (AMA) updating the Current Procedural Terminology (CPT) to support providers in coding and billing for coronavirus testing.
The AMA announced the addition of CPT code 87635 in 2020 for novel coronavirus testing through infection agent detection by nucleic acid. They also released the codes 86328 and 86769 for COVID-19 antibody tests and the revision for SARS-CoV-2 nucleic acid tests (86318). Other codes have been created for antibody tests of single step methods and multiple step methods. The AMA also released 11 scenarios that providers can use to determine which code is appropriate for testing at their office.
On the Healthcare Common Procedure Coding System (HCPCS) side, CMS released two codes, U0001 and U0002 for COVID-19 tests that are performed at CDC labs and clinical labs outside the CDC respectively.
As testing becomes more sophisticated and providers make additional choices around how to select and administer these tests, billing and coding will become more complex.
A New Era of Telehealth Billing
This might be the most serious change for providers in the COVID-19 era since telehealth is uncharted territory for so many. Hospitals are using telehealth to triage patients, while many individual practices are stepping into telehealth for the first time, and home health agencies are finding new ways to incorporate the practice. While HHS has relaxed rules around telehealth billing, the relaxation isn’t permanent, and providers should be prepared for changes that stretch toward a more sustainable use of telehealth billing and coding in the future.
Tips to Move Forward and Outsource Medical Billing
If you’re considering outsourcing medical billing, there are a few steps you can take today to ensure you make choices that are the best for your organization.
Accept That This is a Crisis Response
First off, understand that the choices you’re making now aren’t in response to the status quo. Your organization, your medical billing and coding included, is in a period of long-term crisis response and your decisions should reflect that. For example, look at this revenue cycle advice for emergency departments (ED) revenue cycle processes. It encourages ED leaders to [2]:
- Monitor financial indicators and make frequent adjustments since results may not be as consistent and predictable as usual
- Rethink staffing models since patient distribution has shifted
- Prioritize strong leadership as a driver of organizational culture during a time of crisis
The takeaway here is that your consideration to outsource medical billing should be part of a plan to adapt to change across your organization.
Pay Attention to Individual Payers
While your entire organization might be responding to a crisis, it will be helpful to look at the behavior of individual payers when deciding if you should outsource medical billing. This is because shifts in payer guidelines will directly impact your workflow, tech, and staffing decisions.
For example, United Health Care has issued a new COVID-19 Billing Guide for 2021 [3]. The guide covers billing and claim submission for vaccines, testing, treatment, medical supplies, and urgent care scenarios. You can expect other payers to issue similar documents, meaning your internal teams will have an additional layer of responsibility — one that will reverberate across the revenue cycle if you don’t stay on top of it.
Look for Opportunities
While pandemic billing changes do mean challenges for your revenue cycle, they can also mean opportunities to improve. These include a chance to educate your team on telehealth, identify technology that will bring you up-to-date with modern revenue cycle practices, and invest in data in a way that aligns your medical coding with the revenue cycle of the future.
Another opportunity is the chance to outsource medical billing in a way that best fits your organization. To learn about your options around where an experienced partner can fit in your COVID-19 response strategy, start here.
References
[1] J. LaPointe, “What Providers Need to Know About COVID-19 Coding and Billing,” RevCycleIntelligence, 17 April 2020. Available: https://revcycleintelligence.com/news/what-providers-need-to-know-about-covid-19-coding-and-billing.
[2] RevCycleIntelligence, “3 Revenue Cycle Management Strategies for EDs in a Time of Crisis,” 18 May 2020. Available: https://revcycleintelligence.com/news/3-revenue-cycle-management-strategies-for-eds-in-a-time-of-crisis.
[3] UnitedHealthcare, “UnitedHealthcare COVID-19 billing guide,” 13 May 2021. Available: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2020/covid19/UHC-COVID-19-Provider-Billing-Guidance.pdf.
