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COVID-19 Claims
Coding and billing for accurate reimbursement

Your hospital has taken a significant loss of revenue as you have had to delay or temporarily eliminate elective procedures to free up space for the anticipated surge of COVID-19 cases. As a result, you may be operating with reduced staff and resources at a time when you need “all hands-on deck” to capture all available revenue, weed through recent regulatory changes impacting patient care and other business office functions, particularly coding and billing.

While the urge may be to bill as quickly as possible, now more than ever, it’s important for your team to pay close attention to how these COVID-19 related claims are going out the door.

Recommended hard stops to ensure full and accurate reimbursement:

• Understanding the regulatory flexibilities offered during this period is a great first step to ensure you will receive the full and accurate reimbursement to which you are entitled.
• Create internal processes to review the coding and billing on all COVID-19 related claims, particularly as it applies to the new coding and payer-specific billing guidelines.
• Set up worklists. Establish a set of criteria to capture all potential COVID-19 related claims, one worklist for before April 1, 2020 where interim guidelines apply, and another for April 1, 2020 and after where the new coding and guidelines apply. Incorporate the applicable ICD-10-CM codes in each worklist configuration, and have these claims reviewed by a second level before they are released for billing. For example,
• Worklist 1 for Dates of Discharge through 3.31.20 might include B97.29, J12.89, J20.8, J40, J22, J98.8, J80, R05, R50.9, R06.02, Z03.818, and Z20.828.
• Worklist 2 for Dates of Discharge 4.1.20 forward might include U07.1, B97.29, J12.89, J20.8, J40, J22, J98.8, J80, R05, R50.9, R06.02, Z03.818, and Z20.828.
• A third Worklist may include PCS codes related to mechanical ventilation: 5A1935Z, 5A1945Z, 5A1955Z.

Contact us directly and we’ll be happy to share any other information we have or help you research your specific situation.