How Will Medical Billing Change Post-Pandemic?

June 17, 2020 by Antonio Arias, MBA, CHBME

Topics: Medical Billing


With over two million cases and more than 115,000 deaths across the United States (as of June 2020), the COVID-19 pandemic has proven to be the most devastating public health crises in generations. The initial wave of state-imposed lockdowns that went into effect during March and April may have successfully slowed the virus from spreading, but it continues to pose a threat as people begin to venture from their homes once again. Healthcare providers are still grappling with the full implications of the crisis, including the ways it will change the medical billing process in both the near term and the long term.

The Impact of COVID-19 on the Medical Billing Industry

While the initial impact of the pandemic certainly affected the way medical providers delivered services, the crisis has also exposed a series of deeper problems lingering just below the surface of the healthcare industry. While supply chain vulnerabilities and hospital capacity have garnered most of the headlines, more medical practices are likely to be affected in terms of insurance billing.

As a recent Harvard Business Review article humorously pointed out, there may be a billing code for something as obscure as being injured while knitting, but many activities associated with coronavirus treatment have yet to receive specific billing codes. This is especially true when it comes to procuring necessary medical supplies (such as masks that can be issued to patients). While these codes are slowly being rolled out to medical providers (more on that in a moment), billing guidelines are changing so rapidly that it’s difficult for many practices to keep up to date.

More importantly, health insurance companies are experiencing severe disruption to their business model. Coronavirus-related costs may be skyrocketing across the country, but statewide lockdowns on non-essential, elective medical procedures have allowed insurance companies to absorb those costs without cutting into their revenue. In many cases, insurers are temporarily waiving copayments and deductibles for COVID-19 treatments. This approach has worked so far, but the situation could change should claims for elective procedures return to their normal levels. When insurance companies reveal their proposed premiums and reimbursement rates for 2021, there could potentially be serious implications for many healthcare practices.

Medical Billing for Telehealth

One of the few benefits of the COVID-19 crisis has been the federal government’s decision to relax billing restrictions on telehealth services. The Department of Health and Human Services (HHS) announced in March that Medicare coverage would be expanded to include audio/visual telehealth visits, virtual check-ins, and e-visits. Further regulatory restrictions were waived in April, but there are still uncertainties about whether or not these changes will mark the beginning of a permanent shift toward expanded telehealth services.

This ambiguity puts healthcare practices in an awkward situation. While there are currently plenty of incentives to expand telehealth services, there is a chance that insurance reimbursements for those services could return to pre-pandemic levels within the next few years. Given that many practices are still using a variety of social distancing measures to protect staff and patients, however, it seems likely that more practices will be making use of telehealth technology, which will make it difficult for regulators to reinstitute the previous restrictions.

New COVID-19 Testing Codes

There have already been many new billing codes issued so healthcare providers can bill for COVID-19 testing. While the development and use of these codes continue to evolve, there are several codes healthcare practices should be aware of.

ICD-10 Code U07.1

The Centers for Disease Control (CDC) announced this ICD-10 code in March and originally planned to implement it in October of 2020. The rapid spread of the virus, however, caused it to implement the code in April. Providers are instructed to only use U07.1 for confirmed COVID-19 cases. Additional codes related to comorbidities or other symptoms can be sequenced after U07.1.

CPT Code 87635

Added to the Current Procedural Terminology (CPT) code set by the American Medical Association (AMA) in March, code 87635 is to be used for novel coronavirus tests that involve nucleic acid amplification. This is the test that involves swabbing the nasal cavity, which has a high concentration of the virus in infected patients.

CPT Codes 86328 & 86769

Unveiled in April, these codes are used for two different forms of antibody testing, which has been used to study the immune system’s response to COVID-19 and provide a better idea of how the virus is spreading throughout the country.

HCPCS Codes U0001 & U0002

Developed by the Centers for Medicare & Medicaid Services (CMS), these codes were rolled out in March to allow providers to bill for COVID-19 diagnostic tests in CDC testing labs (U0001) and non-CDC testing labs (U0002).

Prepare Your Medical Practice for the Future of Medical Billing with the Help of NCG!

Staying on top of the latest trends in billing and coding for insurance reimbursement is challenging at the best of times. It’s even more difficult in the midst of an unprecedented pandemic that has already upended many longstanding trends in the healthcare industry. By outsourcing your health insurance billing to a third-party provider like NCG Medical, you can focus on delivering outstanding medical care while we make sure your insurance claims are using the most up-to-date billing and coding practices. To learn more about how our experienced team can help improve your revenue cycle management and stay ahead of COVID-19 billing trends, contact us today.


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