Are you billing the correct CPT Codes?
Healthcare organizations are dealing with an onslaught of changes. Along with navigating the diagnosis, treatment and documentation of an otherwise unfamiliar virus, healthcare workers are faced with a more diverse group of patients, adding to the complexity of establishing coding for COVID-19.
The following coding and reporting guidelines, laid out by the CDC and World Health Organization, aim to more accurately capture COVID-19 practices:
87635: SARS-COV-2 COVID-19 AMP PRB
86318: IMMUNOASSAY INFECTIOUS AGENT ANTIBODY
86328: IA NFCT AB SARSCOV2 COVID19
86769: SARS-COV-2 COVID-19 ANTIBODY
For more information on how to use the CPT code, please visit: COVID19 CPT Testing
HCPCS Code National Payment Rate:
U0001- (2019-ncov diagnostic) = $35.91
U0002- (Covid-19 lab test non-cdc) = $51.31
Claims processing systems will begin accepting these codes on April 1, 2020 for dates of service on or after February 4, 2020.
Effective March 18, 2020, until the end of the Public Health Emergency, CMS is waiving coinsurance and deductible amounts under Medicare Part B for Medicare patients for certain COVID-19 testing-related services. The cost sharing waiver applies to medical visits when an outpatient provider, physician, or other providers and suppliers that bill medicare for Part B services orders or administers COVID-19 lab tests U0001 U0002, or 87635,
Support for U.S. Healthcare Systems
HHS and the Trump Administration are working together to allocate and distribute $100 billion in funding for providers in the CARES Act as quickly as possible to those most in need. An additional $10 billion will be allocated to providers in high impact areas, $50 billion to providers across the board, $10 billion to rural providers, and $400 million to the Indian healthcare system.
Hospitals Without Walls
CMS is facilitating the ability for hospitals to provide services in other healthcare facilities and sites outside of their existing departments. This includes setting up expansion sites such as remote location or sites and hotels or community facilities, allowing hospitals to separate infected patients and control the spread of infection.
Under this initiative, CMS has also relaxed a myriad of conditions and provider-based rules for hospital operations in an attempt to increase the focus on patient care. These waivers are helping hospitals to:
Screen patients offsite
Lessen hospital paperwork requirements
Enhanced flexibilities during hospital and CAH surges
Increase bed numbers and length of stay at Critical Access Hospitals
Ease of access to necessary care through telemedicine
COVID-19 Diagnostic Testing
Hospital outpatient departments can be paid for symptom assessment and specimen collection for COVID-19 using a new HCPCS code C9803, retroactive to March 1, 2020. The FDA has authorized the COVID-19 antibody tests to be covered as a Medicare diagnostic test for patients with known or current infection.
Coronavirus fraud has cost consumers an overwhelming $12 million to date. Threats of this nature are severely compromising efforts to contain the virus and could have grave impacts in patient care. Recent scams include:
Fake drive-through testing sites
Sites have been reported in KY, AL, AZ, FL, GA & NY
Unapproved & misbranded products
Illegal coronavirus-related telemarketing calls
Phishing & malware scams
Threat to Labs
Healthcare organizations, including testing labs, have been exposed to an influx in cybersecurity threats since the early stages of the COVID-19 crisis. The World Health Organization (WHO) has seen a significant increase in attempts, including an unsuccessful attack to penetrate and steal their internal emails.
Together with the FDA, the FTC has issued warning letters to 7 companies advertising and selling unapproved and misbranded products. The FTC plans to further enforce and take action against fraudulent and unsupported products that directly pose a threat to consumers.
Across the globe, cybersecurity professionals are offering up their time, expertise and even free access to their resources to fight the security concerns and ward off hackers.
In Europe, a group of information security professionals, Cyber Volunteers (CV19), are providing ongoing support to healthcare services.