VISIT PREPARATION AND PLANNING

Focusing on visit preparation and planning is critically important for resuming in-person visits and maintaining virtual services. Looking at the current state of the people and processes and what the potential future state will be in these three areas will impact reimbursement. Getting it right prior to the patient encounter is key. Focusing on accurate demographic and insurance information, eligibility and patient communication of financial responsibility will yield less re-work and delayed reimbursement post visit. Equally important is the accountability of your teams at the time of the visit and post visit to ensure the revenue cycle process is seamless. Continuing to explore virtual staffing and technology will be important to get back on track with the necessary data.​

 

 

MAINTAINING AND CONVERTING SERVICES

Maintaining virtual ancillary services to continue patient and staff safety and focus on provider visits and testing ramp up gives your waiting room areas and patient flow more capacity. It may make sense to keep your device patients remote and continue offering various methods for Coumadin Clinic patients to maintain their care. For projections of capacity consider what percentage of these ancillary patients will require in-person services and the expected timeline. Many of these services require timeframes for reimbursement – ensure you are not overlapping service periods and that charges are being captured since these services are not face-to-face.

 

 

Overview of Coding Guidance COVID-19 - NEW!

The CDC provided updated guidance effective for coding and reporting ICD-10 CM Diagnosis codes during COVID-19. These guidelines are effective for services April 1, 2020 to September 30, 2020.  Click here to download the official guidance

  • U07.1 should only be used for confirmed cases of COVID-19 with positive or presumptive-positive test results.
  • U07.1 should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of OB pts.
  • COVID-19 is not confirmed or if testing is negative, the following Encounter Codes should be used:
    • Z11.59 - Encounter for screening for other viral diseases
    • Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out
    • Z20.828 - Contact with and (suspected) exposure to other viral communicable diseases
 

 

Diagnosis Coding and Documentation - NEW!

Keeping up with optimal documentation during this difficult time and the evolving changes may be challenging. Here are some considerations when documenting and selecting the applicable diagnosis code.

 

 

Improve A/R - Improved Cash Flow - NEW!

Accurate, efficient revenue cycle management is essential to maintaining positive cash flow. With decreased volumes in our programs of charges, coding, etc. focus those teams on the Accounts Receivable (A/R). Days in A/R measures how quickly claims are paid. The median for Days in A/R is generally less than or equal to 40-45 days. This average for Medicare is too high - a clean claim may be paid by Medicare in 14 days. The sweet spot for most unpaid claims is 60 to 90 days old. The collectability of receivables aged 121-150 days falls to approximately 55 percent, and A/R over 180 days old plummets to five percent recovery. Here are some high-level considerations to get started.