Category: Revenue Cycle Management

Contactless Payments

Post COVID-19: Medical Billing Finally Realizes the Value of Text-to-Pay

Contactless payments were on the rise even before COVID-19 hit. But now, health systems should see them as essential. Consumers are increasingly wary of touching a credit card terminal that others have used, a perfect conduit for spreading germs. For consumers, text payments serve as a convenient contactless way to pay, but there are other unique benefits […]
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Remote Patient Monitoring Update: Developments and Opportunities for Physicians

Remote Patient Monitoring Update: Developments and Opportunities for Physicians

Heading into 2020, adoption of telehealth services was already on the rise. Then the health crisis hit. Now it appears that COVID-19 has not only cemented telehealth’s place in the healthcare landscape but done so in a very big way. McKinsey & Co. is projecting that virtual visits could potentially account for $250 billion, or 20%, of […]
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Payers are reimbursing providers for all COVID-19-related testing and treatment they are furnishing to their insured members, but what if the patient is uninsured? Healthcare providers need not write off COVID-19 testing and treatment services rendered to uninsured patients. Compensation is available! The public health emergency for COVID-19 requires the healthcare industry to focus their efforts on treating patients and testing individuals for COVID-19 and, until recently, ceasing all “non-essential” services. As a result, healthcare providers are losing significant revenue this year. Recognizing this, Congress has passed various legislation this year that allows the U.S. Department of Health and Human Services (HHS) to reimburses providers for COVID-19-related services furnished to the uninsured. Providers who conduct COVID-19 testing or provide treatment for uninsured patients with a COVID-19 diagnosis on or after Feb. 4, 2020, can e-file claims for reimbursement via the COVID-19 Uninsured Program Portal. What is the COVID-19 Uninsured Program Portal? The COVID-19 Uninsured Program portal is being administered by UnitedHealth Group through a contract with the HHS Health Resources and Services Administration (HRSA). The program is being funded by the Families First Coronavirus Response Act and the Paycheck Protection Program and Health Care Enhancement Act, which each appropriate $1 billion to reimburse providers for conducting COVID-19 testing for the uninsured. A portion of the funding appropriated in the Provider Relief Fund will be used to support expenses related to the treatment of uninsured individuals diagnosed with COVID-19. What COVID-19 Services Are Reimbursable? Providers can receive reimbursement for providing the following COVID-19-releated services to uninsured patients: • Specimen collection, diagnostic and antibody testing • Testing-related visits provided in office/telehealth, urgent care, or emergency room settings • Treatment (in most settings, including telehealth) • FDA-approved vaccine (once available) Services not covered by traditional Medicare are not reimbursable. Also not covered for payment under the COVID-19 Uninsured Program: • Any treatment without a COVID-19 primary diagnosis (except for pregnancy O98.5-, when a COVID-19 diagnosis may be secondary) • Hospice services • Outpatient prescription drugs All claims are final. The Centers for Medicare & Medicaid Services (CMS) will not accept interim bills, corrected claims, late charges, voided claims transactions, or appeals via the COVID-19 Uninsured Program Portal. How Do Providers File COVID-19 Claims for the Uninsured? To participate, providers must attest during registration that they have confirmed the patients were in fact uninsured and no other payer will reimburse them for the services. For example, individuals who are enrolled in a state’s Medicaid program, or have coverage for treatment services through the COVID-19 testing eligibility group, are not uninsured for the purposes of this HRSA-administered program. Steps: o Enroll as a provider participant on the HRSA COVID-19 Uninsured Program Portal. o Validate Taxpayer Identification Number o Set up Optum Pay™ ACH for direct deposit o Add provider roster o Check patient eligibility o Submit patient information o Add and attest to patient roster o Submit claims electronically for professional and facility services using the ANSI X12 837 and Payer ID 95964 Note: THE HRSA COVID-19 Uninsured Program uses a unique version of Smart Edits to detect claims with potential errors. Repaired claims should be sent with the original frequency code of 1, not with a replacement or voided claim indicator of 7 or 8. Providers will receive payment via direct deposit. For any new codes where a Medicare published rate does not exist, claims will be held until CMS publishes corresponding reimbursement information. Providers must accept the program reimbursement as payment in full and agree not to balance bill the patient. Payments will be “generally at Medicare rates,” according to the HRSA. Take note: Providers may be subject to post-reimbursement audits. How Do I Code COVID-19 Testing and Treatment Claims? For confirmed COVID-19, use ICD-10-CM code B97.29 Other coronavirus as the cause of diseases classified elsewhere as the primary diagnosis (or secondary diagnosis, when pregnancy is the primary diagnosis) in applicable claims with dates of service between Feb. 4, 2020, and April 1, 2020. For claims with dates of service on or after April 1, 2020, use U07.1 COVID-19. For diagnostic testing and testing-related services performed in an office, urgent care or emergency room, labs, or via telehealth, report, as appropriate: Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19) Z20.828 Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19) Z11.59 Encounter for screening for other viral diseases (asymptomatic) For More Information: https://www.aapc.com/blog/51136-get-paid-for-covid-19-testing-treatment-of-uninsured/

Get Paid for COVID-19 Testing/Treatment of Uninsured

Payers are reimbursing providers for all COVID-19-related testing and treatment they are furnishing to their insured members, but what if the patient is uninsured? Healthcare providers need not write off COVID-19 testing and treatment services rendered to uninsured patients. Compensation is available! The public health emergency for COVID-19 requires the healthcare industry to focus their […]
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Telemedicine Reimbursemnt

Beyond the Pandemic: Telemedicine Reimbursement and Health Policy

Telemedicine reimbursement and other regulatory flexibilities enabled providers to quickly pivot operations for COVID-19, but temporary policies also poised the health policy landscape for significant change after the pandemic. In the wake of the first confirmed cases of COVID-19 in the US, policymakers quickly relaxed long-standing healthcare regulations, including telemedicine reimbursement and healthcare fraud prevention […]
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Value-based Payment

How Value-Based Payments Support Physicians During a Crisis

Value-based payments support telehealth, data analytics, and other capabilities providers need to effectively respond to crises like COVID-19, says SWHR’s Sanjay Doddamani, MD. More practices are going to want to get their revenue through value-based payments following the COVID-19 pandemic, according to heart failure cardiologist Sanjay Doddamani, MD. The pandemic has shown the best of […]
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COVID-19 Testing Guidance

HHS Issues Requirements for Additional Data and Timely Submission of COVID-19 Testing

With concerns of COVID-19 having a disproportionate impact on certain individuals, such as minorities and the elderly, public health experts are requiring more detailed data, provided on a real-time basis – further supporting the reliability and integrity of data being central to healthcare. Though rates of new COVID-19 cases in the U.S. have somewhat stabilized, […]
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Health Systems

Efficiency Key to Health System Financial Stability After COVID-19

As Eisenhower Health reopens following the peak of COVID-19, leaders are leaning on technology and strategies that improve efficiency to ensure health system financial stability during the recession. When COVID-19 really hit the Coachella Valley area of California in mid-March, volumes dropped by as much as 60 percent at Eisenhower Health. For a health system […]
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Skilled Nursing Facilities

Skilled Nursing Facilities Facing a Financial Crisis from COVID-19

Deemed the epicenter of COVID-19 deaths by many, skilled nursing facilities and other nursing home providers are now on the verge of collapsing without financial help, industry leaders say. Skilled nursing facilities are on the verge of collapsing due to historic underfunding and the financial repercussion of the COVID-19 crisis, according to a new report from the […]
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Telehealth Reimbursement

Providers Want Equal Telehealth Reimbursement Beyond COVID-19

With telehealth reimbursement flexibilities set to expire following the public health emergency period, providers are calling on HHS and policymakers to continue payment parity beyond COVID-19. Telehealth use has increased dramatically in a matter of weeks, enabling providers to continue seeing patients despite social distancing and shelter-at-home restrictions due to COVID-19. But these advancements could […]
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Telehealth Services

New Bill Would Codify Medicare Reimbursement for Telehealth Services

The bipartisan HEALTH Act would make permanent Medicare payments for telehealth services at federally qualified health centers and rural health clinics. U.S. Reps. G.K. Butterfield, D-North Carolina, and Glenn Thompson, R-Pa., introduced new legislation this week that would provide for permanent Medicare payments for telehealth services at federally qualified health centers and rural health clinics. The Helping […]
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