4 Quick Tips for Getting COVID-19 Claims Paid Promptly

4 Quick Tips for Getting COVID-19 Claims Paid Promptly
Lillian Phelps, Sr. Director of Product Management, Availity

As the COVID-19 pandemic has gripped the world, many providers have adopted an all-hands-on-deck approach and mentality for treating COVID-19 patients, stretching their resources to the breaking point. 

We have heard about the frontline heroes who have sacrificed their own health and safety to treat patients and, in less-fortunate scenarios, comfort patients in their last moments as they were quarantined from loved ones. 

What has been less recognized is the work and sacrifice put forth by providers’ back-office staff. Many back-office workers have had to transform their operational practices after shifting to “work-from-home” mode to avoid potential exposure and minimize traffic to hospitals and physicians’ offices. 

In addition to working in new environments, some of these back-office administrators who help process claims, receive reimbursements, check eligibility and manage denials are also seeing a higher volume of claims that are more complicated in nature due to the severity and complexity of managing COVID-19 symptoms in patients. Others are working with bare-bones staff as elective procedure volumes have decreased. 

The biggest challenges with COVID-19 claims
While many aspects of the pandemic are beyond providers’ control, proper coding of COVID-19 claims is one area they can focus on to help ensure efficient operations and revenues. Of course, that is easier said than done. The following are just a few challenges providers have been facing with COVID-19 claims.

Increased complexity: Due to the complexity of COVID-19 cases, which affect many elderly patients and those patients with chronic conditions and comorbidities, associated claims often take longer to code, file and process compared to more straightforward cases. More complex COVID-19 cases lead to longer hospital stays, which can create delays in submitting claims, resulting in delays in receiving reimbursements.

Continued shift to electronic transactions: While many hospitals and provider groups have shifted to submitting claims electronically, many processes, including prior-authorizations, eligibility and estimation requests and grievances, and appeals, rely heavily on manual intervention. These processes frequently require access to faxed or paper documents. Administrative staff members have had to quickly learn new systems and processes.

Difficulties with reimbursement for the uninsured: Through the Coronavirus Aid, Relief, and Economic Security Act (also known as the CARES Act) and other legislation, the federal government has appropriated funding earmarked for providers that deliver COVID-19 testing and treatment to the uninsured. While this was certainly a welcome gesture at a time when many have lost their health insurance due to unemployment, the support has come with some administrative strings attached that lead to challenges for providers. 

For example, before submitting a claim, providers must show they have gone through an attestation process and document their efforts to find other medical coverage for the patient. Then providers essentially have just one shot at submitting a clean claim, as there is no appeals process for denials deemed inappropriate or unjustified. In cases of denials, providers themselves have little recourse for obtaining reimbursement and end up with a loss in revenue and increased costs. Although the efforts to help uninsured patients with COVID-19 testing and treatment are well-intentioned, providers must follow specific steps to realize the benefits.

Processing COVID-19 claims more efficiently
It has become clear that COVID-19 claims, though in many ways similar to traditional claims, have unique impediments that create difficulties for hospital and provider administrators. We have observed this in our own data. When comparing COVID-19 claims to non-COVID-19 claims, the COVID-19 claims have demonstrated a greater error rate (9-12% compared with 5-7%) and a longer time to submit (45 days compared to 30 days).

Despite these challenges, providers can implement the following steps to manage the workload, process COVID-19 claims efficiently, and work within the constraints of their new “work-from-home” offices.

1. Leverage technology that identifies errors and provides upfront edits to all COVID-19 claims. Automated revenue cycle solutions should contain updated functionality to properly review claims and flag potential issues prior to the claim being submitted to a payer.

2. Move coverage discovery to the front end of the billing process and ensure it is performed for all patients. There are many solutions that will search for insurance coverage across both commercial and government payers. When identified, the payer information can be reviewed and added to a patient’s billing information.

3. Review analytics within the revenue cycle management system to identify COVID-19 claims. Analyze these claims by payer, claim amount, and number and severity of services rendered. Scrubbing and editing claims in advance will ensure accuracy while also highlighting anomalies to review and fix prior to submitting the claim.

4. Constantly review claims for inpatient stays to ensure that all charges are recorded and all medical records are updated and attached. Getting all documentation ready and prepared in advance will save time on the backend.

Though we all hope that the pandemic winds down and we soon return to some sense of normalcy, it takes more than hope for providers to get their COVID-19 claims reimbursed accurately and quickly. Following the tips above will help keep administrative processes running smoothly and alleviate burdens that will inevitably occur once patients are treated and the billing cycle continues. 


About Lillian Phelps

Lillian Phelps is the senior director of product management for Availity, the nation’s largest health information network.


Open APIs in Healthcare: The Future of Data Integration Report

Open APIs in Healthcare: The Future of Data Integration Report

What You Should Know:

– The latest Chilmark Research report examines how data-oriented APIs are contributing to development and integration efforts across healthcare from the perspective of the developer.

– Reeling from the impact of the COVID-19 pandemic and
seeking more effective ways to implement new functionality, healthcare
enterprises of all kinds are looking to alternatives for prevailing development
and integration practices.


Unlocking value
from the data scattered across healthcare communities was once a tantalizing
opportunity. After COVID-19,
it is an existential necessity. Chilmark
Research’s
latest Market Trends Report, Open APIs in Healthcare: The Future of Data Integration, captures a market whose approach to data access and
integration will be changing substantially in the coming years and introduces a
subvertical within healthcare
IT
that anticipates a 16% CAGR through 2025.

APIs Are Still New in Healthcare

What You Should Know:  - Latest Chilmark Research report, examines how data-oriented APIs are contributing to development and integration efforts across healthcare from the perspective of the developer. - Reeling from the impact of the COVID-19 pandemic and seeking more effective ways to implement new functionality, healthcare enterprises of all kinds are looking to alternatives for prevailing development and integration practices.  Unlocking value from the data scattered across healthcare communities was once a tantalizing opportunity. After COVID-19, it is an existential necessity. Chilmark Research’s latest Market Trends Report, Open APIs in Healthcare: The Future of Data Integration, captures a market whose approach to data access and integration will be changing substantially in the coming years and introduces a subvertical within healthcare IT that anticipates a 16% CAGR through 2025.   APIs Are Still New in Healthcare  Outside healthcare, the ascendance of data access and integration facilitated by application programming interfaces (APIs) is the culmination of decades of technology evolution and implementation lessons with distributed applications. Across the SaaS landscape in particular, APIs have become the preferred method for accessing data and conducting transactions across applications and organizations. Developers recognize and appreciate the value of loosely coupling their applications and data, wherever each is located. Inside healthcare, many enterprises are hesitant on the topic of APIs, seeing them as too big a leap from established, successful software practices. But they also recognize that eliminating the need for hard-coded interfaces that must be re-implemented every time an application or its underlying data changes will deliver higher programmer productivity and more-responsive applications.   Traditional Integration Methods Fall Short Conventional development and integration approaches proved cumbersome and slow in efforts to contribute to understanding or responding to the current health crisis. Unlocking more value from the data scattered across healthcare communities is — post-COVID-19 — a critical element in clinical and financial renewal. “Enterprises across healthcare were already wrestling with challenging market forces and government mandates,” says Brian Murphy, the report’s lead author and analyst. “Open APIs will play a central role for providers, payers, or any healthcare enterprises that intend to better utilize their data and pursue development efforts that make them — and the broader healthcare community — more responsive and adaptable to the demands of a post-pandemic healthcare system.” Developers Require Accessible Data Developers find data wherever they can from among a large and confusing mix of data holders and associated vendors. This report identifies the sources where different kinds of health-related data are most likely to be API-accessible. It shows how APIs are already contributing to development and integration efforts across healthcare and estimates the much larger potential of widespread adoption. This report includes detailed profiles on 20 public and private organizations and their offerings, including 1upHealth, 4Medica, Allscripts, Apple, Athenahealth, Availity, Blue Button 2.0, Cerner, Change Healthcare, Datica, Epic, Human API, Meditech, NextGen, NCPDP, Particle Health, The Sequoia Project, Redox, Surescripts, and Validic. For more information about the report, visit https://www.chilmarkresearch.com/chilmark_report/open-apis-in-healthcare-the-future-of-data-integration/

Outside healthcare, the ascendance of
data access and integration facilitated by application programming interfaces
(APIs) is the culmination of decades of technology evolution and implementation
lessons with distributed applications. Across the SaaS landscape in particular,
APIs have become the preferred method for accessing data and conducting
transactions across applications and organizations. Developers recognize and
appreciate the value of loosely coupling their applications and data, wherever
each is located.

Inside healthcare, many enterprises are
hesitant on the topic of APIs, seeing them as too big a leap from established,
successful software practices. But they also recognize that eliminating the
need for hard-coded interfaces that must be re-implemented every time an
application or its underlying data changes will deliver higher programmer
productivity and more-responsive applications.

Traditional Integration Methods Fall
Short

Conventional development and
integration approaches proved cumbersome and slow in efforts to contribute to
understanding or responding to the current health crisis. Unlocking more value
from the data scattered across healthcare communities is — post-COVID-19 —
a critical element in clinical and
financial renewal.

“Enterprises across healthcare were already wrestling with challenging market forces and government mandates,” says Brian Murphy, the report’s lead author and analyst. “Open APIs will play a central role for providers, payers, or any healthcare enterprises that intend to better utilize their data and pursue development efforts that make them — and the broader healthcare community — more responsive and adaptable to the demands of a post-pandemic healthcare system.”

Developers Require Accessible Data

Open APIs in Healthcare: The Future of Data Integration Report

Developers find data wherever they can from among a large
and confusing mix of data holders and associated vendors. This report
identifies the sources where different kinds of health-related data are most
likely to be API-accessible. It shows how APIs are already contributing to
development and integration efforts across healthcare and estimates the much
larger potential of widespread adoption.

This report includes detailed profiles on 20 public and
private organizations and their offerings, including 1upHealth, 4Medica,
Allscripts, Apple, Athenahealth, Availity, Blue Button 2.0, Cerner, Change
Healthcare, Datica, Epic, Human API, Meditech, NextGen, NCPDP, Particle Health,
The Sequoia Project, Redox, Surescripts, and Validic.

For more information about the
report, visit https://www.chilmarkresearch.com/chilmark_report/open-apis-in-healthcare-the-future-of-data-integration/