Best practices and Guidelines for Coding of COVID-19 testing and vaccination claims.
Customer Situation
Our client, a Maryland-based Medical Billing & Coding Company, was challenged with billing & coding for all vaccinations done at an urgent care clinic in North Carolina, which had partnered with the North Carolina Department of Health & Human Services to run the majority of local vaccination drives.
Challenges
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200,000+ charges were pending to be billed under the HRSA program & other payers
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All information regarding the Vaccination should be registered on the NCDHHS (North Carolina Department of Health and Human Services) website, which in coordination with federal, state, and local partners, is responding to the COVID-19 pandemic
Results Summary
Solution
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Working with the billing company, we identified the processes for claims submission and created a set of best practices for billing and coding of COVID-19 vaccination and testing claims.
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We recognized that all claims should be submitted to the insurance company and the HRSA uninsured program for self-pay patients through the Practice Management system
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The MBW team was trained on the new billing & coding guidelines of the HRSA program while working from home
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We trained the billers to load the demographic details of all vaccinated patients into a front-end system called Unity
Procedure codes for COVID-19 Vaccination as per Brand name and dosage
CPT Codes for COVID-19 testing and Vaccination
Result
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The MBW submitted around 70,000 claims adding up to a value of $14.5M as of 25/05
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We have also collected $2.7M for the charges out of the $6m that were billed as of 30/04
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Collectins to the tune of $3.5 million is anticipated for the remaining claims
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60,000 patient were registered on the NCDHHS website and entered into the Unity system
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40,000 patient claims were registered under the Health Resources & Service Administration Program for the Uninsured
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By applying best practices in billing and coding for COVID-19 testing and vaccination claims, this engagement recovered $14.5 million in lost revenue.
To understand how this approach strengthens revenue cycle performance for COVID-19–related claims, submit the form below to access the case study. A member of our team will connect with you soon.