America's Health Insurance Plans and the Healthcare Financial Management Association are together offering voluntary guidance for how providers should code and bill COVID-19 care delivered in alternate inpatient settings.
Alternate care sites have been essential to health systems during the COVID-19 pandemic, from the use of ambulatory surgical centers to rehabilitation facilities, parking lots and convention centers.
New diagnosis and billing codes have been introduced to capture this activity and ensure proper payment. But clinicians and insurers are struggling to keep up with seemingly constant changes in how they are expected to bill and adjudicate claims, AHIP and HFMA said.
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WHY THIS MATTERS
By adopting coding practices agreed upon by insurers, health systems can get paid faster. The system also improves accuracy to reduce administrative burden.
Providers can access clear and concise guidance to code and bill for inpatient services in alternative care sites.
AHIP and HFMA expect to issue voluntary billing guidance for outpatient services soon.
THE LARGER TREND
While voluntary, this guidance reflects some legal requirements of the Medicare program, as well as laws such as the Health Insurance Portability and Accountability Act (HIPAA) and the Families First Coronavirus Response Act (CARES Act).
ON THE RECORD
"Clinicians have been nimble in adapting to new care settings and the financial side must keep pace," said HFMA President and CEO Joseph J. Fifer. "This voluntary guidance will go a long way toward streamlining the COVID-19 billing and payment process, which benefits everyone – most importantly consumers."
"We stand with America's healthcare heroes on the front lines," said Matt Eyles, president and CEO of AHIP. "We are committed to working together – because together, we can overcome this crisis."
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