MEDICAL BILLING BLOG

CMS Seeks Faster COVID-19 Lab Results

CMS is working to ensure that patients who test positive for the virus are alerted quickly so they can self-isolate and receive medical treatment. Thus, under President Trump’s leadership, the Centers for Medicare & Medicaid Services posted an October 15 announcement of new actions to pay for expedited COVID-19 test results.

Back on April 15, CMS Administrator Seema Verma announced, “CMS has made a critical move to ensure adequate reimbursement for advanced technology that can process a large volume of COVID-19 tests rapidly and accurately.” At that time, Medicare payment to laboratories for high throughput COVID-19 diagnostic tests was increased from approximately $51 to $100 per test.

Now, to encourage labs to increase the rapidity in receiving results, beginning January 1, 2021, Medicare will pay $100 only to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen being collected. Medicare will pay a rate of $75 to laboratories that take longer than two days to complete these tests, effective also on January 1, 2021.

“As America continues to grapple with the COVID-19 pandemic, prompt testing turnaround times are more important than ever,” said CMS Administrator Seema Verma. This updated payment announcement “supports faster high throughput testing, which will allow patients and physicians to act quickly and decisively with respect to treatment decisions, physical isolation, and contact tracing. President Trump continues to lead the most robust testing effort anywhere in the world.”

Amended Administrative Ruling (CMS 2020-1-R2)

This amended ruling, effective January 1, 2021, lowers the base payment amount for COVID-19 diagnostic tests run on high-throughput technology from $100 to $75 in accordance with CMS’s assessment of the resources needed to perform those tests.

Then, Medicare will make an additional $25 add-on payment to laboratories for a COVID-19 diagnostic tests run on high-throughput technology if the laboratory: (1) completes the test in two calendar days or less, and (2) completes the majority of their COVID-19 diagnostic tests that use high throughput technology in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month.

HCPCS Code U0005

CMS established these requirements to support faster high throughput COVID-19 diagnostic testing and to ensure all patients (not just Medicare patients) benefit from faster testing. These actions will be implemented under the amended Administrative Ruling (CMS-2020-1-R2) and coding instructions for the $25 add-on payment (HCPCS Code U0005) released October 15.

According to CMS, “The new payment amounts effective January 1, 2021 ($100 and $75) reflect the resource costs laboratories face for completing COVID-19 diagnostics tests using high throughput technology in a timely fashion during the Public Health Emergency."

Impact on Laboratories

This CMS update may have an impact on laboratories’ logistics and/or sample collections beginning with dates of service from January 21, 2021, forward. Please note that the two-day clock starts when the sample is COLLECTED, not when it is received by the lab.

It appears this updated policy is measured on a monthly basis. The two scenarios seem to be:

   1. In the prior month, the lab completes the majority of ALL COVID-19 tests (across all payers, not just Medicare) in 2 days or less from sample collection, and the two codes are billed: 
       a. COVID-19 test (U0004), which will pay $75
       b. Fast completion code (U0005), which will pay $25 

   2. In the prior month, the lab does not complete the majority of ALL COVID-19 tests (across all payers, not just Medicare) in 2 days or less from sample collection, and the one code is billed: 
       a. COVID-19 test (U0004), which will pay $75

Questions Will Be Asked

Undoubtedly, laboratories will have questions regarding this updated policy, and I feel sure additional information will be coming from CMS to answer such questions as:

1. What does “majority” mean? Simple majority? Super majority?  

2. Do both the test being billed AND the majority of tests from prior months need to be completed in two days or less? If you visit the CMS source, the text is not clear on this point.  

3. What if the issue is with the sample source and not with the lab when it comes to missing the two-day mark?

 When ClaimCare uncovers more information regarding this updated policy, we will posting it via our blogs.

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About ClaimCare ®                        

ClaimCare has 30 years of medical billing experience. We have an established 100% USA-based medical billing team that has been assembled through a thorough pre-employment screening. All personnel participate in on-going training and strong process management to ensure they deliver only the highest quality medical billing services to ClaimCare clients.

ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website. We can assist your practice and/or facility in numerous ways, including complete certification processing.

100% USA-Based HIPAA-Compliant Medical Billing Company

We are posting this blog for ClaimCare clients and for other medical practices and facilities who have not yet become clients. During this continuing COVID-19 pandemic, we want to proactively explain to all in the healthcare industry why your Account Receivables may be behaving differently than anyone would expect.

In a previous blog I shared how ClaimCare spent significant time, energy and money putting in place a fully-tested, HIPAA-compliant work-from-home option several years ago following a flu season that hit ClaimCare and the nation hard. 

Thus, we are one of the relatively few companies with no interruption or slowdown whatsoever in serving our clients in a timely and responsible manner. This cannot be said about many insurance payers.

Even though ClaimCare has been working our clients’ ARs consistently and hard throughout the COVID-19 pandemic, we are not getting the results these efforts would normally yield. This is because many payers entered the crisis unprepared and are now woefully understaffed.

Anything that requires “human intervention” in order to resolve appeals and other forms of claims reprocessing is taking much longer than normal. Some of our clients’ ARs have not decreased over the past three months as much as we normally are accustomed to seeing due to bottlenecks caused by payers. For example:

• With one very large payer that we can normally call and have a claim put back into reprocess on the same day, we now have difficulty in even conversing with a human.
• Medicare appeals normally take about 30 days to resolve, but now we have claims in appeals from March that still have not processed due to Medicare staff shortages.
• We left multiple messages for the Supervisor of one Medicare Advantage group, and when she finally returned our call she said, “We are doing the best we can, but we can’t give you an update yet on your appeals.”

ClaimCare continues to be very aggressive with these payers within the constraints of an unprecedented event limiting their staffing. We have found chains of command to be very thin and the Insurance Commissioner unable to get involved with pandemic-related slowdowns. We will eventually obtain what is due to our clients because we feel our 100% USA-based team is the best, most professional and most prepared to get the job done.

If anyone reading this blog post – client or non-client – has any specific questions or concerns regarding this current situation, please don’t hesitate to contact us. We in the healthcare industry are all in this together, working to achieve the best for patients, practices, facilities and America.

About ClaimCare ®                        

ClaimCare has 30 years of medical billing experience. We have an established 100% USA-based medical billing team that has been assembled through a thorough pre-employment screening. All personnel participate in on-going training and strong process management to ensure they deliver only the highest quality medical billing services to clients.

ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website. We can assist your practice and/or facility in numerous ways, including complete certification processing.

The AMGA 2017 Medical Group Operations and Finance Survey reported that operating costs losses per physician jumped from a 10 percent loss of net revenue in 2016 to a 17.5 percent loss a year later. Thus, the total losses per physician during this two-year period went from $95,138 to $140,856.

With these increasing revenue losses, to help reduce operational costs more and more healthcare providers are choosing to outsource their medical billing rather than keeping it in-house.

If you are considering a move to outsource your billing, it behooves you to understand the 3 types of medical billing companies. This basic knowledge will help you decide which type best fits your needs, allowing you to focus on your core operations.

Medical billing companies vary with the services they offer, and are categorized as such:

1. Light Service Medical Billing Companies

These are billing software vendors. Their services include handling of coding validation and working rejections due to authorizations, eligibility, and patient demographics.

Due to the limited services such companies deliver, which include processing the front end billing process and processing your claims, they are designed for practices that have an expert in-house medical billing staff in place.

2. Full Service Medical Billing Companies

These are the traditional medical billing companies that initiate their services during the earlier stages of your revenue cycle. They are equipped and skilled to:

• Provide your practice with technology tools and training for demographics, card issuance information, and eligibility verification, which is most helpful during the check-in process
• Work with rejected claims and assist you on how to avoid this from happening in the future
• Communicate with practices regarding how to manage rejections.

They have the capacity to handle all of your medical billing concerns. This makes them the ideal choice for medium to large practices aiming to focus on their core operations.

3. Boutique Medical Billing Companies

Sometimes what’s required is a medical billing company that can provide more specific assistance to your specialized practice. This is where boutique types of medical billing companies are extremely valuable.

Boutique medical billing companies can deliver customized services to specialized practices and facilities that wish to go beyond the common simple payment postings, claims submissions, and account receivables follow-up. However, this also means a higher service fee because of their unique customized approach to medical billing.

Which type of medical billing company would best suit your practice or facility?

It depends on your requirements. If you have a limited in-house billing staff, choosing a full-service or a boutique billing company would be ideal. However, if you have the resources to handle most of this on your own and only require a software to assist you, then a light service medical billing company could help you achieve your goals.

About ClaimCare

ClaimCare has over 17 years of medical billing experience with all employees being 100% U.S.A.-based. Our services include denial management, electronic medical record implementation, fixing of broken medical billing processes, and expedited billing service. Subscribe to our blog or call us toll-free at (855) 376-7631 for any of your medical billing queries and concerns.