‘Documentation is key’: 6 takeaways on optimizing reimbursement amid COVID-19

September 15, 2020

Optimizing reimbursement during the COVID-19 pandemic will play a key role in how effectively hospitals and health systems move forward financially after the public health crisis.
During an April 27 webinar hosted by Becker’s Hospital Review and sponsored by Zotec Partners, industry leaders provided a business-focused overview of legislation affecting reimbursement for hospitals, including the Coronavirus Aid, Relief and Economic Security Act. Additionally, the conversation addressed coding and documentation for COVID-19 patients.

The presenters included:

  • Ed Gaines, JD, CCP, vice president of regulatory affairs and industry liaison, Zotec Partners
  • Pamela Nealy, BSN, CPC, CEDC, director of client service – coding education, Zotec Partners

Six takeaways from the presenters:

  1. The Paycheck Protection Program is a “no brainer” for most healthcare providers that meet employer requirements, said Mr. Gaines. The program provides funding for employers with fewer than 500 employees via grants that do not require repayment. The purpose of the program is to help eligible businesses keep people on the payroll during the pandemic. Mr. Gaines encouraged eligible healthcare provider groups to get their application in as soon as possible.
  2. The Coronavirus Aid, Relief and Economic Security Act, signed by President Donald Trump March 27, initially included $100 billion to pay healthcare providers for coronavirus-related expenses or lost revenue. The first $30 billion of $50 billion in general grant funds was allocated between April 10 and April 17 based on historical share of Medicare revenue. The remaining $20 billion in grant funds was allocated April 24. Of the original $100 billion, there is also $20.4 billion targeted for hospitals in “hot zones” hardest hit by the pandemic and hospitals in rural areas.
  3. Separate from the $100 billion fund, President Donald Trump signed a $484 billion relief bill on April 24 that includes $75 billion for hospitals and $25 billion to increase COVID-19 testing. Mr. Gaines said the new $75 billion in funds for hospitals “has promise,” but the process for distributing the funds is unclear.
  4. CMS’ Accelerated and Advanced Payments Program was the fastest way for hospitals to get an infusion of cash amid the pandemic. However, the agency recently suspended advance Medicare payments to Part B suppliers, including physicians, other medical professionals and durable medical equipment suppliers, said Mr. Gaines. CMS stopped accepting new applications from Part B suppliers on April 26 and is reevaluating the accelerated payments to hospitals. 
  5. To optimize reimbursement from the federal government and commercial health plans — and help fight back against denials later — hospitals must ensure they capture the data on their COVID-19 testing and treatment, said Ms. Nealy. This includes data on COVID-19 patients, such as if telehealth services were provided and appropriate coronavirus-related coding modifiers. “Documentation is key,” she said. “We understand the physicians are very busy treating patients. They’re seeing patients in different areas. They’re seeing them in triage tents, different office spaces. They’re using new methods to assess their patients. We understand that, but we have to keep in mind they have to document all of these services.”
  6. There have historically been many regulations around telehealth. But amid the pandemic, CMS has broadened access to these services. For instance, if a physician is quarantined but well enough to perform telehealth services, they can do so from home instead of the hospital, said Ms. Nealy. The federal government also is allowing out-of-state physicians provide telehealth services in states with large COVID-19 outbreaks.  With these relaxed regulations and broadened access, Ms. Nealy said there is an opportunity for telehealth to be a health IT game changer.

To learn more about Zotec Partners, click here. For more COVID-19 legislative and regulatory information, click here. To listen to the full webinar, click here.

Published in Becker’s Hospital Review, August 2020