Are you in confusion over COVID-19 coding and claim requirements?

According to a new survey that confusion over COVID-19 medical coding and insurance claim requirements is one of the top effects the pandemic has had on revenue cycle management in the healthcare industry.

Alpha Health conducted a survey through the Healthcare Financial Management Association’s Pulse program, they inquired 587 chief financial authorities and revenue cycle management leaders at hospitals and health systems across the US how COVID-19 has impacted revenue cycle management.

Almost half of the respondents were unpredictable work/claim volumes, followed by an increase in increase in workloads due to confusion over codes and requirements for COVID-19-related claims (37.0 percent).

The major impact of COVID-19 on revenue cycle management was overstaffing due to decreases in claim volumes (35.8 percent), decreases in staff productivity due to rapid and unplanned move to working remotely (34.7 percent), and decreases in staff productivity due to lay-offs, furloughs, and other staff reductions (32 percent).

Out of 587, very few respondents said that they were understaffed due to an increase in claim volumes (4.2 percent) or that decreases in staff productivity due to several members of the team being sick with COVID-19 (2.9 percent).

This survey shows a confidence level of 95 percent with a margin of error of plus or minus 5 percent, Alpha Health noted.

According to Malinka Walaliyadde, co-founder and CEO of Alpha Health, “COVID-19 has disrupted all facets of life and work, and health systems and hospitals have had to adjust quickly to new realities. As health systems continue to experience volatility in claims volume, they will need to take quick action to identify gaps in claims-handling capacity, and update operational and staffing practices accordingly.”

At the start of the pandemic hospital volumes severely hit a historically with some service lines seeing as much as a 99 percent decrease under shelter-in-place orders.

Visits and revenues are starting to pick up back as communities which were considered as a hotspot of the pandemic reopen and resume activities, including elective, non-emergent care. However, this revenue cycle recovery depends on the location of providers and whether their communities are slated to experience a possible second wave of the COVID-19 virus.

Unpredictability in the healthcare industry due to coronavirus is creating revenue cycle challenges, which are now being made worse by constantly upcoming and evolving COVID-19 coding and billing policies and workforce obstacles.

For example, the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed in late March 2020 provided a Medicare add-on payment of 20 percent for hospitals billing the federal healthcare program for inpatient hospital COVID-19 patients.

CMS clarified that a positive COVID-19 test must be documented in the patient’s medical record in order for hospitals to be eligible for the add-on payment. New codes are also regularly developing to make sure accurate documentation and billing of COVID-19 care.

Providers have to be thoroughly followed the billing and coding guidance from the government agencies like CMS and the CDC, as well as the American Medical Association (AMA) and other official organizations, says Maria Noelle Ward, MEd, RHIA, CCS, CCS-P, the former director of HIM practice excellence at AHIMA.

Your staff or your medical billing company should be well-informed of COVID-19 billing and coding guidance is crucial to ensuring a smooth revenue cycle and accurate reimbursement for the treatment of patients during a pandemic.

Automation may help your practice and hospitals to overcome the challenge of COVID-19 billing and coding while creating a stronger revenue cycle that can adjust quickly to the changes in claim volumes and requirements in near future. “These efforts will be critical to ensure the short- and long-term health of their organizations, their employees, and the communities they serve,” the healthcare technology leader stated.

“It would seem most CFOs understand what the pandemic has proved is the need to speed up digital transformation initiatives to not only survive but to prosper in the new normal. For CFOs eager to expedite their organization’s digital transformation, the standardization and simplification leaders want in their back-end processes are allowing for less complicated, faster adoption despite the times,” the survey’s author explained.

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