COVID pandemic is dominating the world so far. However doctors and healthcare professionals dedicate their lives to provide us with the healthcare and support we need. But are the healthcare professionals being paid for the services?
CMS and CDC have come up with an addition to the existing ICD 10. On January 30, 2020, the World Health Organization (WHO) declared the 2019 Novel Coronavirus (2019-nCoV) disease outbreak a public health emergency of international concern. As a result of the declaration, the WHO Family of International Classifications (WHOFIC) Network Classification and Statistics Advisory Committee (CSAC) convened an emergency meeting on January 31, 2020 to discuss the creation of a specific code for this new coronavirus. A new International Classification of Diseases, Tenth Revision (ICD-10) emergency code (U07.1, 2019-nCoV acute respiratory disease) has been established by WHO.
From then till now, these codes are being updated every month after the recent cases and development of patient’s condition. Each case of COVID infection depends upon a patient’s immunity, their previous respiratory disorders/infections etc. and so patient history plays a vital part in the diagnosis and treatment.
In the billing process where the COVID diagnosis and the procedures entered, then filed to insurance as a clean claim. But the issue with the current updated ICD -10 COVID code and rapidly updating of these codes creates denials because of the lack of updates in the insurance companies CCI edits and the clash with provider contracts.
We have seen many COVID testing and E&M codes being denied as (M80) not paid separately or as (CO45) charges exceeds fee schedule/maximum allowable and invalid procedure/diagnosis codes. When we contacted the respective insurance companies, their claims team responded us that they are still updated these codes in provider contracts and their CCI edits and it would take several months for these claims to be reprocessed and paid.
The resolution of these types of denials is to have a contact directly with the claim adjudicators in the insurance companies and submit the list of denied claims and place regular follow ups via email.
This not only prevents the revenue loss for the doctor but also makes easier to follow up on future denials with less time consumption. Few of the insurance companies which allow contacting them directly are
Medica
Hennepin Health
Health Partners
Humana
Cigna
Aetna
Most federal payers like Medicare directly process the claims. Only state payers and other commercial payers are lagging behind in this process. So it is always good to inform insurance company and create a footprint with them, which allows them to acknowledge that we provide COVID and COVID related tests and treatments.Connect with our Sales Team and learn more about the trusted, industry-leading denial management services.
