How Should Physicians Document to Ease Medical Billing Issues During the COVID-19 Pandemic?

Healthcare practitioners should stay careful while documenting to serve patients with COVID-19. They should also avoid medical billing and payment issues in the months and years after the pandemic. 

It is still unsure what the blanket waivers cover versus what happens under specific waivers versus what governors are going to state for collection management for the healthcare industry. In this article, we have mentioned strategies to avoid emergencies for months and years following the coronavirus. 

• Consider National Emergency:
  
  

The Trump administration has declared a national emergency and it has granted HHS the authority to waive certain Medicare, Medicaid, and CHIP policies and allow states to offer flexibilities for local medical professionals. It is essential for providers to manage pandemic with a finite amount of resources. A national emergency is inevitable for the healthcare business. Access to billions of dollars is the significant impact of National emergency for service providers. The economic portion is huge because hospitals and other providers are already getting hit very hard. 

• Declaration:
  
  

The declaration is essential to manage patient implications for providers. You can’t get the regulatory relief under Section 1135 unless you also have the president declare a national emergency in your state during the COVID-19 pandemic. According to CMS.gov, 1135 waivers enable the HHS Secretary to “take certain actions in addition to her regular authorities,” such as temporarily waiving or modifying certain Medicare, Medicaid, and CHIP requirements to beneficiaries of these programs have access to sufficient healthcare resources and services during national and public health emergencies. The waivers also ensure practitioners who provide the services in good faith are reimbursed and exempted from sanctions during the crisis.

These waivers and extra flexibility will assist providers to get through the high wave of infected patients already showing up at their doors. There are over already 46,500 confirmed cases of COVID-19 in the US, according to the latest data from Johns Hopkins University. According to infectious disease experts, that number is expected to increase up to 96 million patients.

• Define the limit of your healthcare facility:
  
  

Physicians have a surge of COVID-19 patients and the entire continuum of care is trying to prepare and figure out how they’re going to accommodate these patients within existing regulations. These waivers should provide alternatives to enable healthcare practitioners to manage that patient surge. 

For instance, it is very difficult for critical access hospitals to prepare rapid influx for COVID-19 patients. On one side, hospitals want more number of inpatient beds available to patients presenting with symptoms. On the other side, hospitals only qualify for critical access hospital reimbursement if the facility has 25 or fewer inpatient beds.

The major challenge for critical access hospitals attempting is to combat that pandemic. The recent blanket waiver approved by HHS will relax that rule and allow critical access hospitals to expand capacity and provide reimbursement for it. 

HHS has approved only the following key blanket waivers due to the COVID-19 pandemic;

• The 3-day rule for skilled nursing facilities, which requires a 3-day before hospitalization for coverage of a skilled nursing facility (SNF) stay.
• Requirements pertaining to front end encounters, physician’s orders, and new medical required documentation for durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) lost, destroyed, irreparably damaged, or otherwise rendered unusable. 
• 25-day average stay length requirement for long-term care hospitals.
• Rules regarding the use of step-down beds for acute care patients
• Requirements that out-of-state providers be licensed in the state where they are providing services.
• These blanket waivers will apply to all medical professionals automatically to enable the effective and quick treatment of patients with COVID-19. HHS is also approving additional flexibility at the state level.

But these aren’t the only waivers available to healthcare practitioners struggling to create the required capacity to accommodate infected patients. 

• Compliance with Federal laws:
  
  

Providers typically seek waivers of federal laws and Conditions of Part (COP), which say a provider can execute healthcare revenue cycle management and receive reimbursed payment for Medicare and Medicaid claims. These laws and regulations are critically aligned to ensure patient safety but the requirements can become a major obstacle to deliver timely care in an urge of emergency. 

For instance, the Emergency Medical Treatment and Labor Act (EMTALA) forbids the transfer of unstabilized patients. However, hospitals may get to a point where they don’t have the capacity to stabilize all patients. 

Instead of having these patients sit in the waiting room with potentially non-symptomatic patients, hospitals should immediately transfer these to another facility that has greater capacity. 

Providers also frequently apply for 1135 waivers during emergencies to relax reporting deadlines and fraud, waste and abuse regulations. These waivers prevent providers from potential financial penalties or sanctions stemming from care delivery in good faith under extreme and uncontrollable situations. 

However, providers should forward justified and supportable requests. They should accurately document a reason why they need this relief. This is the only process that hinders the availability of 1335 waivers that frequently. Although, providers need to apply for waiver 1335 as soon as possible. 

HHS is going to receive a lot of waivers and it is very important for providers to get in line. Internal staffing has not been increased in the healthcare authorities. Providers can be seen at the front end as soon as they can get in waivers. 

Providers should accurately document why are they billing this way. If they would not appropriately code the reason with real prove then they are going to be a backlog or vulnerability at the end. It’s critical to focus on accurate documentation as there have been no waivers of documentation. 

• Acquire the assistance of medical billing professionals:
  
  

It is extremely difficult for healthcare practitioners to completely engage their medical staff in healthcare revenue cycle management practices. Therefore, they should partner with a reliable medical billing benefits company that can manage and keeps a record of complete information that could be used during and after the pandemic to prevent any issues with waivers. It would help healthcare practitioners to seamlessly continue their practices. A professional medical billing company would help to accurately configure your administrative side and run your business in a streamlined way.