Patient Balances During the Public Health Emergency

Much has been said about how insurers will cover telehealth and COVID-19 claims with no cost-sharing. As always, the devil is in the details– in many cases, this only applies to patients with certain diagnosis codes submitted with specific modifiers. If the plan is employer-sponsored, it is up to the employer how telehealth will be covered. 

Predictably, the reality of claims adjudication does not match the sound bites patients hear on the news. Two specific examples for you to mull over: Aetna released a statement acknowledging that they’ve processed many telehealth claims incorrectly and said they would automatically reprocess all telehealth claims to fix these errors.  Horizon’s website says telehealth claims will covered without cost-sharing, but 30% of the telehealth claims we’ve received back have patient responsibility. This creates an administrative nightmare that we need to work together to carefully sort through. Incorrectly processed patient balances during this emergency will lead to angry patients and money out of your pocket. 

In an effort to make this as efficient as possible, please contact us and kindly let us know which approach you’d like us to take in handling your patient balances during this public health emergency.
We want to customize our process for your practice and will follow these rules for all claims with dates of service from March 1st, 2020 – June 30th, 2020. 

Should we: 
a) Bill the patient per how insurance processed the claims 
b) Automatically write off any patient balance from a telehealth or COVID-19 claim. Medicare has explicitly stated providers can waive cost-sharing during this public health emergency. 
c) Put all patient balances in your missing information report for you to review individually 
d) If the claim has any one of the COVID-19 related diagnosis codes listed below, automatically resubmit the claim with the Z20.828 diagnosis code and any relevant cost-sharing modifiers. Per the American Hospital Association, Z20.828 should be used if a patient has a known or suspected exposure to COVID-19, is exhibiting signs/symptoms associated with COVID-19, and the test results are negative, inconclusive, or unknown. According to guideline I.C.21.c.1 Contact/Exposure, Z20 codes may be used for patients who are in an area where a disease is epidemic. Z20.828 may be assigned without explicit documentation of exposure or suspected exposure to COVID-19.