Providers Confused by COVID-19 Coding, Claim Requirements

Erratic claim volumes and confusion over COVID-19 coding and claim requirements are the top issues impacting revenue cycle operations, according to a new survey of financial leaders at US hospitals and health systems.

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Conducted through the Healthcare Financial Management Association's (HFMA) Pulse Survey program, the survey commissioned by Alpha Health asked 587 chief financial officers and revenue cycle leaders at hospitals and health systems across the US how COVID-19 has impacted revenue cycle operations.

The most cited impact selected by half of respondents (50.5 percent) was unpredictable work/claim volumes, followed by an increase in workloads due to confusion over codes and requirements for COVID-19-related claims (37.0 percent).

Rounding out the top five impacts of COVID-19 on revenue cycle operations 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 (32.0 percent).

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

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

“COVID-19 has disrupted all facets of life and work, and health systems and hospitals have had to adjust quickly to new realities," said Malinka Walaliyadde, co-founder and CEO of Alpha Health. "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.”

Hospital volumes hit a historic low at the start of the pandemic, with some service lines seeing as much as a 99 percent decrease under shelter-in-place orders.

Visits, and therefore revenues, are starting to pick back up as communities in what was once considered the epicenter of the pandemic reopen and resume normal activities, including elective, non-emergent care. However, this revenue cycle recovery depends on where providers are located and whether their communities are slated to experience a possible second wave of the virus.

This unpredictability is creating revenue cycle management challenges, which are being made worse by constantly forthcoming 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.

Earlier this month, though, 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 emerging to ensure accurate documentation and billing of COVID-19 care.

Providers need to be diligently following coding and billing 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.*

“Most importantly, they need to be sure that they're following the coding guidelines, those provided from a visit perspective and the telehealth and the CPT codes, but also the guidelines that have been provided by the CDC for actually coding patients who have COVID,” Ward recently told RevCycleIntelligence.

Staying abreast of COVID-19 coding and billing guidance is crucial to ensuring a smooth revenue cycle and accurate reimbursement for the treatment of patients during a pandemic.

Automation may help hospitals and health systems overcome the challenge of COVID-19 coding and billing, while creating a more resilient revenue cycle that can adapt quickly to changes in claim volumes and requirements going forward, Walaliyadde stated.

“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.

Healthcare financial leaders seem to agree, with just 12 percent of CFOs in a recent survey planning to cut or defer spending on digital transformations of their financial systems.

“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,” the survey’s author explained. “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.”

UPDATED 09/01/2020: Article updated to reflect that Maria Noelle Ward, MEd, RHIA, CCS, CCS-P, is no longer with AHIMA.