COVID-19 and Epic: Patient Friendly Billing Guide

On March 12, 2020, in a primetime coronavirus address, President Trump stated that health insurance industry leaders had agreed to “waive all copayments for coronavirus treatments.” Shortly thereafter, coronavirus patients began to complain to the media about health systems billing them for coronavirus testing and treatment.

Given the international attention focused on the COVID-19 pandemic and the recent sensitivity revolving around incorrectly billing patient responsibility, clients should consider avoiding collection of patient responsibility for COVID-19-related services, including holding statements until there is more clarity around what patients will owe.

Ensemble recommends that clients take the following steps:

• Create a reason code for POS Non-Payment or Non-Collection. Several of our clients use custom items built into registration workflows, while other use the standard non-collection reason category list to track this. We recommend adding a reason of “COVID-19” to this category list and training staff responsible for collecting POS payments on when to select this value.
• Configure a CDM code in the procedure master file specific to the new COVID-19 CPT code, 87635. If certain payers require a charge using a HCPCS Level II code, you may need to set up alternate CPT code logic in the procedure master file.
• Work with your coding team to identify diagnosis codes that may indicate the presence of COVID-19 and make sure they are built in your diagnosis code master file. Ensemble recommends that our clients at least consider B97.29, Z03.818, Z20.828, and U07.1 as diagnoses used for potential Coronavirus cases.
• Create billing indicators that indicate if a patient has been tested, diagnosed, or has the COVID-19 POS collection status. Build a system actions to apply the billing indicators based on the presence of
  • The previously mentioned procedure code for patients that have been tested
  • The diagnosis codes for patients that have been diagnosed
  • The POS Collection Status for patients that have been flagged by an associate during the POS collection process. NOTE: SBO organizations will want to be sure to also flag PB-only HARs.
• Single Billing Office (SBO) organizations should create a statement skip reason and associated rule looking for the presence of the previously created billing indicators.
• Non-SBO organizations will need to configure a PB statement intervention that looks for the COVID-19 CPT code, diagnoses, and POS non-collection status to hold PB statements, in addition to the HB statement skip configuration.

  Please note the following before starting your Epic build:

• The qualification criteria mentioned above are intentionally conservative to err on the side of billing patient responsibility correctly. This same rule criteria should not be used for reporting the number of confirmed COVID-19 cases.
• The configurations described in this document may require modification if CMS releases new guidelines regarding COVD-19.
• Each client’s Epic environment is different. All build must be thoroughly tested before it is moved to Production.
• These are complex and rapidly evolving issues, and it is not possible for all of the factors that may impact whether these procedures are suitable to be considered here. These suggestions should be carefully scrutinized by your organization to independently determine if they are appropriate for implementation. These recommendations do not create a contractual relationship and Ensemble is not responsible for any losses associated with implementing these procedures. You should consult with your revenue cycle provider about your organization’s individual circumstances. For further information regarding these issues, contactSolutions@ensemblehp.com.

COVID-19 Facility Coding Grid

CPT/HCPCS Codes for Labs

Diagnosis Codes:

These are common diagnosis codes seen with COVID-19 (but is NOT all inclusive)

Common DRGs – BEFORE APRIL 1st

Please note that COVID-19 will not link to a specific DRG as the scenario will vary by patient. That being said, the most common DRGs that we will see are as follows:

Common DRGs – AFTER APRIL 1st

The ICD-10 MCE Version 37.1 R1 uses edits for the ICD-10 codes reported to validate correct coding on claims for discharges on or after April 1, 2020.

The ICD-10 MS-DRG Grouper software package to accommodate this new code, Version 37.1 R1, is effective for discharges on or after April 1, 2020.

Assignment of new ICD-10-CM diagnosis code U07.1, COVID-19, is as follows:

epic_configuration_covid19_billing.pdf