Customer Situation
2020 challenged all healthcare clinics and institutions worldwide to partner with government bodies to treat, prevent & help eradicate covid-19. All healthcare providers and payers came together as a community and collaborated with other non-profit partners and organizations. They equipped their clinic and trained other volunteers and staff in a way that can help them offer the best healthcare possible during these unprecedented times.
Amidst these uncertainties, our client, a healthcare provider in Central Florida, had launched Covid-19 testing for both insured and uninsured patients. While insured claims were reimbursed successfully, the client needed an RCM partner to submit claims electronically under the HRSA program.
Challenges
-
Received a backlog of 1,000+ patient claims for submission under the HRSA program
-
Training the staff to understand the new and evolving policies for COVID test claims for insured and uninsured individuals
-
Acquisition of information & education on the CPTs, ICDs, and payer details from www.hrsa.gov websiteThe Providers did not provide the right level of specificity to the diagnosis codes, which adversely impacted the clean claim submission rate
-
Submission of clean claims and getting paid in the first submission itself is critical as the HRSA program does not consider corrected bills or late submissions and appeals
-
Most of the claims were already generated using a temporary ID, which is valid for 30 days from the date of service. The client had not been able to file the claims for tests performed, and many of the claims were older than three months.
Results Summary
Solution
-
We educated the team on the HRSA guidelines. As most of our team members worked from home, we set up a daily cadence of meetings to impart training.
-
The team billed the correct CPT “87635” & Dx code Z03.818 by strictly adhering to the HRSA guidelines
-
Correct usage of the payer name: “COVID 19 HRSA Uninsured Testing & Treatment fund” and the Insurance type: “HRSA Program.”
-
Used the Temporary member ID as the Subscriber ID
-
Proper usage of the CLIA# & CLIA waive test modifier (QW)
Result
-
Detailed training program ensured consistent understanding of the HRSA guidelines for submitting COVID-19 testing claims
-
Error-free submission of over 1,000 claims worth $168K and net collections of $60K
-
Adherence to all IT security policies in a challenging work from home environment
-
Improved monthly collections from $33,242 in August by 25% i.e., $41,809.in December
-
Achieved targeted business outcomes and achieved a 100% client satisfaction score
Schedule a consultation
By navigating HRSA program requirements and optimizing billing workflows for uninsured COVID-19 testing, this approach enabled timely and accurate reimbursements.
To review how this process strengthens revenue cycle performance for COVID testing of uninsured patients, submit the form below to access the case study. Our team will connect with you soon.