The American Medical Association (AMA) recently announced the approval of a new addition to the CPT by the CPT Editorial Panel. This was done in an effort to improve tracking, allocating, and optimizing resources in the face of the COVID-19 pandemic. This will help physicians bill for procedures that combat the novel coronavirus.

The New Code and Descriptor

“87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique” This CPT code is now effective as the industry standard for reporting testing of the novel coronavirus in the US healthcare system. Further information can be found on The American Medical Association website. Short, medium, and long descriptors can be accessed at the AMA website.

Operation Update for Quest National Services

At this time we are running business as usual, but we are closely monitoring guidelines from the Center of Disease Control (CDC), World Health Organization, OSHA, and decrees from our state and federal government. Our office is considered “Low Exposure” due to the minimal occupational contact we have with the general public, our Orlando headquarters is in a 4-story building shared with many tenants across different business platforms; our Waco office has numerous tenants across a variety of business platforms as well. We certainly can’t control who comes in and out of our buildings but we can control who comes in and out of our facilities. We’re taking the following measures to maintain our level of service to our clients:

• We are requiring all employees to maintain a clean and sanitary work environment
• Our administration is doing hourly surface-level cleaning
• Visitors are required to utilize sanitizer upon entering our facility and be in general good health
• We as an organization are doing everything to keep our employees healthy by maintaining a sanitized work environment
• If our office closes due to any circumstances we do have a contingency plan to ensure claims and payments continue processing as normal

Our entire management team is monitoring on a daily basis federal, state, and local mandates and our plan is to continue operating as normal until otherwise instructed and/or mandated by our government. Our primary goal to ensure that you know we are here if you have questions. If you or your office is interested in exploring a free telemedicine platform, please contact us to learn more.

During the COVID-19 public health emergency, telemedicine offers medical practices the ability to continue caring for their patients both with and without COVID-19. In order to mitigate exposure of patients who are sick or at-risk due to other conditions and to protect the healthcare workers and community, practices are strongly encouraged to use telemedicine and telehealth services whenever possible. They are also encouraged to consider establishing protocols and procedures for use by practice staff and clinicians. Now in a full state of emergency, Medicare, Medicaid, and many private insurance restrictions related to telemedicine have been lifted.

Patients can be at home and non-HIPAA compliant technology is now allowed.

There is no cost-sharing for COVID-19 testing. In addition, to encourage use by patients, Medicare, Medicaid, and some private insurances are allowing practices to waive cost-sharing (copays and deductibles) for all telehealth services. Many prior authorization activities are being paused. There is one caveat here. It seems patients who have been tested for CORVID-19 and have a diagnosis code related to CORVID-19 will have their co-pays, co-insurance, and deductibles waived. With this said there are payers who are waiving all patient cost-sharing but it is on a plan by plan basis.

The Basics of Billing for Telemedicine Services

Telemedicine billing seems to change from day to day, by the payer and by state. While all payers have some form of formal policy in place for how to bill for telemedicine, the COVID-19 impact on insurance is changing almost daily to meet the needs of so many specialties that normally would not need to use these services.

There are a few items to discuss what to expect from different payers, regardless of the state they are in.

How Are Self-Funded Plans Affected?

These are plans where the employer pays for the medical services provided to their employees. These plans are administered by a third-party administrator and currently have full discretion on which services they will allow. Currently, most are not reimbursing providers for telemedicine services.

What Services Are Covered and How Is This Determined?

Many payers will only pay for the services under the patient’s current insurance plan. If it is not a covered service, the payer will not cover the cost and the cost will defer to the patient. The verification of the patients’ eligibility to ensure telemedicine services are covered is essential and begins at the provider’s office.

How Are Private Payers Affected?

Private payers may have their own manner of billing for telemedicine services. For instance, modifiers, procedure codes, and the place of service may be different from that of Medicare and Medicaid.

How is Payer Reimbursement Seen on an Individual Level?

Each payer reimbursement has to be looked at individually. There is not a standard reimbursement rate across the board. Some pay at a reasonable and customary rate or a fixed rate. A few payers will pay at the provider’s contracted rate and of course many will deny your claim. In every one of the aforementioned scenarios, the billers working on the claims will place the claim in a queue for further investigation with the payer to determine if additional funding will be forthcoming.

Updates to Insurance Information

Insurance companies are updating their websites almost daily, so we have a team solely dedicated to finding the answers. Of course, the providers and their teams are also receiving insurance direct correspondence. By working together we can keep everyone updated.

Steps You Can Take

Many doctors aren’t being fully compensated for their telemedicine services. This is largely in part due to the complexity of medical billing for telemedicine services. But we’re here to help. With telemedicine coding and solutions to help you transition during COVID-19. Contact us

Outsourcing your medical billing can seem like a daunting or complex decision for many providers. Although not every outsourcing company is created equal, outsourcing is a great decision for providers across the board.

Although every practice is unique, this guide will help give you the understanding you need to organize a billing department from scratch, audit your own financial collections process, and find out how to grow your revenue.