Quality Measures to Eliminate Denials and Improve COVID Lab Testing Billing

September 30, 2021, bestturtlebeach

COVID pandemic has engulfed the world. It has claimed millions of lives around the world so far and its devastations are still continuing. However, in these difficult times, healthcare providers dedicated their lives to provide much-needed medical support to the people. Without any intention of personal gains, they continue to serve the community for a better cause even on tight budgets. But are the medical practitioners being paid for the services rendered? The majority of the providers are underpaid despite providing quality healthcare services. Therefore, they are in high need to enhance the efficiency of their covid lab testing billing systems.

So they can completely get paid and run their practices without financial interruptions. Nevertheless, in order to ensure the fair compensation of the healthcare providers_ the US federal government has allocated millions of funds and additional incentives. Particularly for those who are providing laboratory services to diagnose viral diseases and vaccinating people. In order to ensure speedy financial recovery and get reimbursements from the insurance companies. Healthcare providers should give equal attention and preference to the covid-19 vaccine billing as they give to their core competencies i.e. patient care.

Because claims denials also occur in covid lab testing medical billing, when it comes to getting payments from government insurance companies. That eventually is a major obstacle in revenue collections and negatively impacts the overall success of a medical facility.

Leading Cause of Claim Denials:

The major cause of claim denials in covid lab testing billing is inaccurate medical coding. Failure to assign the valid diagnostic or procedural codes for covid lab testing medical billing, providing and administering the Covid-19 vaccinations, lead to the delayed, partial and sometimes denied payments. As US federal authorities, CMS and Centers for Disease Control and Prevention (CDC) have unveiled the additions in the ICD-10.

Moreover, soon after the World Health Organization (WHO), declared the Coronavirus, a public health emergency of international concern. The WHO Family of International Classifications (WHOFIC) Network Classification and Statistics Advisory Committee (CSAC) in an emergency meeting, decided to create the specific codes to report the coronavirus. Initially, ICD-10, code_U07.1, 2019-nCoV acute respiratory disease, was established by the WHO.

From then till now, these codes are being updated every month. Now the concerned authorities have also revealed several codes for covid lab testing billing and different vaccinations. However, due to constant updates in the medical codes, the risk of claim denials has been increased. Because such rapid updates usually lead to the lack of timely updates in the insurance companies CCI edits and the clash with provider contracts. Moreover, it has been observed that medical coders fail to keep up with the coding modifications and submit the claims with outdated ones. Which ultimately results in the claim denials. In addition to this lack of attention to detail, which is another major factor behind capturing accurate patients’ information and other billing errors.

Tips to Prevent Denials:

No doubt covid lab testing medical billing is a complicated as well as hectic procedure. Due to the growing complexities, the chances of claim denials increase. However, with the implementation of the right strategies, healthcare providers can prevent excessive claim denials. 

Stay Current With the Industry Regulations

Without knowing the ongoing changes in medical codes, payers policies, and federal/state laws, your medical billing staff cannot file clean medical claims. Therefore, it has become more crucial than ever before to periodically consult the official websites or portals_to stay at the top of any kind of changes related to the covid lab testing billing. Moreover, make sure that your billing and coding staff have complete knowledge about the reimbursement rates and providers eligibility criteria to get reimbursed from the Centers for Medicare & Medicaid Services.

Follow Up with the Payers

As we have already discussed, most of the time claims get denied due to the lack of updates in the payers’ CCI edits. Therefore, practitioners should stay connected with the claim adjudicators in the insurance companies.  In this way, healthcare providers can get real-time information about the status of the claims, either paid or unpaid. If any denial occurs, then billers should immediately come into action and make the appropriate adjustments to make sure that medical professionals get maximum payments back in their accounts. This successful coordination will ultimately prevent revenue loss. 

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