As the prevalence of the new COVID-19 variant, JN.1, continues to surge nationwide, grasping the intricacies of COVID-19 testing billing has become paramount. Recent data from the U.S. Centers for Disease Control and Prevention reveals that JN.1 now constitutes 44% of all COVID-19 infections in the country, underscoring the need for streamlined testing procedures and precise billing.
In response to the ongoing public health emergency, testing capabilities have rapidly expanded, spanning various settings from large reference labs to point-of-care options in clinics and pharmacies. However, staying abreast of reimbursement rules and billing procedures remains a challenge. This blog aims to offer a comprehensive overview of current guidelines across major payers, address common obstacles, and outline strategies for optimizing the revenue cycle to maximize collections.
Key Highlights:
1. CMS COVID Testing Billing:
– Medicare covers diagnostic COVID-19 testing with no cost-sharing during the public health emergency.
– Specific CPT codes, such as 87635 for PCR, 87426 for antigen, and 0224U for antibody, must be used.
– Challenges include denials for incorrect CPT codes and rejections due to a lack of supporting diagnosis code U07.1.
– Staying informed about evolving CMS guidance and leveraging our specialized billing partners can prevent revenue loss.
2. Medicare Advantage Managed Care Plans:
– MA plans follow unique billing procedures, with variations in codes, specimen collection charges, and pre-authorization requirements.
– Our centralized billing experts across multiple payers provide economies of scale in navigating these nuances.
3. Commercial Payer COVID Testing Policies:
– Commercial payers have diverse policies and restrictions regarding COVID diagnostic testing.
– Understanding specific requirements of major insurers such as Aetna, Cigna, Humana, and UnitedHealthcare is crucial for accurate billing.
4. Optimizing Workflow Integration:
– Streamlining workflow integration is essential for successful testing billing, considering the involvement of multiple entities.
– From ordering physicians to national labs and results interfacing with health system EMRs, our efficient data exchange routines prevent delays in claims filing.
5. Patient Billing and Collections:
– Proactive financial counseling with our specialized COVID testing billing knowledge is crucial to address patient questions and issues.
– Ensuring proper communication about waived cost-sharing protections and refunding any incorrectly collected copays or deductibles contributes to smoother collections.
In conclusion, while the landscape of COVID-19 testing billing presents unique challenges, our proactive approach and collaboration with dedicated billing specialists can optimize reimbursement and alleviate the burden on health system revenue cycle teams. As the rules continue to evolve, relying on our expertise and adapting strategies accordingly will be key to navigating this unprecedented public health response.