As the COVID-19 pandemic continues to impact communities around the world, clinical diagnostic labs play a crucial role in testing and monitoring the spread of the virus. In order to ensure proper reimbursement for COVID-19 surveillance testing, it is important for these labs to understand the steps involved in billing for these services. In this article, we will outline the key steps in the billing process for COVID-19 surveillance testing in clinical diagnostic labs.
Step 1: Coding for COVID-19 Surveillance Testing
The first step in billing for COVID-19 surveillance testing is to ensure that the correct CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases, 10th Revision) codes are used for the tests performed. It is important to accurately code for the specific type of COVID-19 test being conducted, whether it is a molecular diagnostic test, antigen test, or antibody test.
Key considerations for coding COVID-19 surveillance testing:
- Use specific CPT codes for COVID-19 tests, such as 87635 for infectious agent detection by nucleic acid (RNA); or 86328 for COVID-19 antigen test.
- Ensure that the ICD-10 code accurately reflects the reason for the test, such as Z11.59 for encounter for screening for other viral diseases.
- Be aware of any specific guidelines or requirements from payers regarding coding for COVID-19 testing.
Step 2: Submitting Claims for COVID-19 Surveillance Testing
Once the tests have been performed and coded appropriately, the next step is to submit claims for reimbursement. It is important to ensure that all necessary information is included on the claim form and that it is submitted to the correct payer in a timely manner.
Key considerations for submitting claims for COVID-19 surveillance testing:
- Include the patient’s demographic information, insurance details, and the specific CPT and ICD-10 codes for the tests performed.
- Provide any required documentation or supporting information, such as a copy of the test results or a physician’s order for the test.
- Submit the claim electronically whenever possible to expedite the reimbursement process.
Step 3: Understanding Reimbursement Guidelines for COVID-19 Surveillance Testing
It is important for clinical diagnostic labs to be familiar with the reimbursement guidelines set forth by different payers for COVID-19 surveillance testing. These guidelines may vary depending on the type of test performed, the setting in which it was conducted, and the specific payer’s policies.
Key considerations for understanding reimbursement guidelines:
- Review the latest guidance from Medicare, Medicaid, and private insurance companies regarding coverage and reimbursement for COVID-19 testing.
- Be aware of any changes or updates to reimbursement rates or policies that may impact billing for COVID-19 surveillance testing.
- Consult with billing experts or coding professionals to ensure compliance with payer guidelines and maximize reimbursement for COVID-19 testing services.
Step 4: Following Up on Denied Claims for COVID-19 Surveillance Testing
In some cases, claims for COVID-19 surveillance testing may be denied for various reasons, such as incomplete or inaccurate information on the claim form, lack of pre-authorization, or failure to meet payer guidelines. It is important for clinical diagnostic labs to follow up on denied claims and take steps to address any issues that may have led to the denial.
Key considerations for following up on denied claims:
- Review the denial notice provided by the payer to determine the reason for the denial and identify any errors that need to be corrected.
- Resubmit the claim with any necessary corrections or additional information, and include a detailed explanation of why the claim should be reconsidered.
- Appeal the denial if necessary, following the payer’s specific appeals process and providing any supporting documentation or evidence to support the claim for reimbursement.
Step 5: Staying Informed on Regulatory Changes for COVID-19 Testing
Given the rapidly evolving nature of the COVID-19 pandemic, it is important for clinical diagnostic labs to stay informed on any regulatory changes or updates that may impact billing for COVID-19 surveillance testing. This includes staying up to date on new CPT codes, coverage policies from payers, and any changes to reimbursement rates.
Key considerations for staying informed on regulatory changes:
- Regularly check for updates from organizations such as the Centers for Medicare & Medicaid Services (CMS), the American Medical Association (AMA), and the Centers for Disease Control and Prevention (CDC) regarding COVID-19 testing guidelines.
- Attend webinars or training sessions on COVID-19 testing billing and reimbursement to stay current on best practices and any changes to regulatory requirements.
- Consult with industry experts or professional associations for guidance on navigating the complex regulatory landscape for COVID-19 testing.
Conclusion
As clinical diagnostic labs continue to play a critical role in COVID-19 surveillance testing, it is essential for them to understand the key steps involved in billing for these services. By accurately coding tests, submitting claims in a timely manner, understanding reimbursement guidelines, following up on denied claims, and staying informed on regulatory changes, labs can ensure proper reimbursement for their COVID-19 testing services. By taking these steps, labs can contribute to the ongoing efforts to monitor and control the spread of the virus.
Disclaimer: The content provided on this blog is for informational purposes only, reflecting the personal opinions and insights of the author(s) on phlebotomy practices and healthcare. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician. Always seek the advice of your doctor or other qualified health provider regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If you think you may have a medical emergency, call 911 or go to the nearest emergency room immediately. No physician-patient relationship is created by this web site or its use. No contributors to this web site make any representations, express or implied, with respect to the information provided herein or to its use. While we strive to share accurate and up-to-date information, we cannot guarantee the completeness, reliability, or accuracy of the content. The blog may also include links to external websites and resources for the convenience of our readers. Please note that linking to other sites does not imply endorsement of their content, practices, or services by us. Readers should use their discretion and judgment while exploring any external links and resources mentioned on this blog.