In a matter of weeks, the US healthcare system has seen dramatic changes as the result of the COVID-19 virus. What was once perceived as an unfathomable situation has become our new normal. How does this effect the workers’ compensation community? The focus for state agencies has been on evaluations, testing, diagnostics, and reimbursement and its impact to medical charges and billing practices.
Important Things to Know
State agencies have released new diagnosis codes, CPT/HCPCS codes and telemedicine guidelines in response to the pandemic. Furthermore, the jurisdictional Workers’ Compensation Boards are continuing to adopt additional COVID-19 billing requirements individually at separate intervals. Medata’s ability to adapt to these changes has been a result of our commitment to compliance since 1975 with weekly, monthly and annual adoption and revisions to nationwide fee schedules.
Medata’s compliance department provides daily research and monitoring of fee schedule updates, Medicare rules, regulatory, legislative, and state reporting changes. This group diligently observes state websites and employs watcher tools that automatically notify the department with any changes. This research results in bi-weekly releases, backed by development and QA departments.
Medata’s bill review software is fully updated for the regulatory items published from beginning of this year. These items include:
- New ICD-Dx codes dedicated to COVID-19 diagnoses (U07.1, U07.2)
- New CPT/HCPCS codes affiliated with COVID-19 treatments (U0001, U0002, 87635, G2023, G2024, …)
- Continued availability of prior Telemedicine Place of Service (02) and Modifier (95, CR) dependencies
- New MS-DRG Grouper derivations for COVID-19 diagnoses
- New DRG reimbursement calculations involving COVID-19 Inpatient Hospital stays
- Medicare’s list of 191 Evaluation and Management, Physical Therapy, Diagnostic Treatments eligible for Telemedicine activities, including the 86 temporary additions effective March 1, 2020
Medata recognizes that some of the new codes are newly defined and as such do not yet have a published allowance or reimbursement rate. As part of our cost containment strategy, Medata is aggressively performing bill studies in a dynamic manner to ascertain the Reasonable amount that should be paid for such services.
Medata Business Intelligence
To understand the full impact of COVID-19, Medata will leverage our Business Intelligence Tool for data mining to obtain relevant billing and treatment information related to any COVID-19 diagnosis, including billing patterns, level of service and care, and overall costs. We look forward to publishing data for the treatment and costs related to this virus.