Use New ICD-10 Codes for Accurate Urgent Care Claims

Regulatory guidelines continue to change as we navigate through COVID-19 and new rules for coding visits. In this month’s “3 Things to Know About RCM,” we provide information on additional COVID-19 ICD-10 codes that just went into effect, the government’s efforts to alleviate provider burden, and tips for avoiding scams at your urgent care clinic.

New COVID-19 Diagnosis Codes Now in Effect

New ICD-10 Codes were officially announced by the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS). These new codes went into effect on January 1, 2021 and replace existing codes that are not specific to COVID-19.

Two additional codes were also announced: M35.81 (Multisystem inflammatory syndrome (MIS)) and M35.89 (Other specified systemic involvement of connective tissue).

5 Big Changes to Interim Final Rule Offer Provider Relieve

The COVID-19 virus continues to roll through the country leaving a legacy of exhausted providers, coding confusion, and unanswered billing questions. With the extension of the public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) published an interim final rule in November covering a broad mix of coronavirus updates. This fourth COVID-19-inspired IFC follows through on CARES Act mandates originally outlined in March. These are the top five takeaways:

1. Private payers: Regarding CARES Act provisions outlined in section 3203, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage provide coverage, without cost sharing, for qualifying coronavirus preventive services, which includes COVID-19 immunizations, according to a CMS fact sheet. The IFC also amends past regulations and guarantees that qualifying COVID-19 preventive services are fast-tracked for rapid coverage.
2. Vaccine rates: CMS will set payment rates for COVID-19 vaccine administration, the IFC suggests. For single doses, Medicare will reimburse at a rate of $28.39. For vaccines with a series of two or more doses, Medicare set a payment rate of $16.94 for the initial dose and $28.39 for the final dose.
3. IPPS: As part of the Inpatient Prospective Payment System (IPPS), the IFC institutes an add-on payment for eligible cases using new and approved COVID-19 treatments. “The enhanced payment will be equal to the lesser of: (1) 65 percent of the operating outlier threshold for the claim; or (2) 65 percent of the cost of a COVID-19 stay beyond the operating Medicare payment (including the 20 percent add-on payment under section 3710 of the CARES Act) for eligible cases,” CMS says.
4. OPPS: Under the Outpatient Prospective Payment System (OPPS), CMS set up a separate payment for new COVID-19 treatments provided at the same time as a Comprehensive Ambulatory Payment Classification (C-APC) service for the duration of the PHE.
5. Testing prices: In accordance with the CARES act, the IFC adds another part to 45 CFR part 182 related to test prices, codifying price transparency requirements for the actual performance of a COVID-19 diagnostic test. Providers of COVID-19 tests must make the cost of the diagnostic test available online, in writing, or in signage within two days of any request. The IFC also puts teeth into enforcement, with possible punishments from warnings to civil monetary penalties (CMPs).

CMS Administrator Seema Verma said in a release, “We have developed a comprehensive plan to support the swift and successful distribution of a safe and effective vaccine for COVID-1. CMS is acting now to remove bureaucratic barriers while ensuring that states, providers, and health plans have the information and direction they need to ensure broad vaccine access and coverage for all Americans.”

COVID Scams are on the Rise ” Train your Staff for Security

According to a Federal Communication Commission (FCC) alert, “As the COVID-19 pandemic continues to impact the United States, the FCC has learned of scam text-message campaigns and robocalls that prey on virus-related fears.”

Scammers texting as representatives of the government lure recipients to click, send, or get in touch, preying on virus-related fears and the uncertainty of day-to-day changes to regulations and restrictions.

The HHS Office of Inspector General (OIG) also updated its COVID-19 scam site on Dec. 3. The OIG warns healthcare operations that “fraudsters are offering COVID-19 tests, HHS grants, and Medicare prescription cards in exchange for personal details, including Medicare information. However, these services are unapproved and illegitimate.”

Both the Cybersecurity and Infrastructure Security Agency (CISA) and the Federal Bureau of Investigation (FBI) have warned repeatedly about ransomware, phishing, and other cyber-attacks targeting the healthcare industry specifically (see Health Information Compliance Alert, Vol. 20, Nos. 9 & 11).

With more remote workers and the increased use of mobile devices, it’s not surprising that more people are falling victim to the hacks. Unfortunately, these hacks can expose patients’ electronic protected health information (ePHI).

Don’t be a victim.

• Educate your employees on the tactics and the risks to ePHI.
• Avoid using mobile devices for sending or receiving ePHI if possible. When there is no other option, be sure devices used for sensitive information are properly secured.
• Check out federal guidance at the HealthIT.gov website for excellent tips for securing mobile devices including advice on password controls, remote wiping protocols, encryption, security updates, and deleting stored health information from devices daily.