Case Study: Recovering $14.5 million by applying best practices in billing and coding of COVID 19 – Test & Vaccination claims
Best practices and Guidelines for Coding of COVID-19 testing and vaccination claims.
Customer Situation
Our client, a Maryland-based Medical Billing & Coding Company, was challenged with billing & coding for all vaccinations done at an urgent care clinic in North Carolina. The urgent care center had partnered with the North Carolina Department of Health & Human Services, thereby conduction the majority of the Vaccination drives at their care centers.
Challenges
200,000+ charges were pending to be billed under the HRSA program & other payers
All information regarding the Vaccination should be registered on the NCDHHS (North Carolina Department of Health and Human Services) website, which in coordination with federal, state, and local partners, is responding to the COVID-19 pandemic
Results Summary
Solution
Working with the billing company, we identified the processes for claims submission and created a set of best practices for billing and coding of COVID-19 vaccination and testing claims.
We recognized that all claims should be submitted to the insurance company and the HRSA uninsured program for self-pay patients through the Practice Management system
The MBW team was trained on the new billing & coding guidelines of the HRSA program while working from home
We trained the billers to load the demographic details of all vaccinated patients into a front-end system called Unity
Procedure codes for COVID-19 Vaccination as per Brand name and dosage
CPT Codes for COVID-19 testing and Vaccination
| CPT | Description |
|---|---|
| U0001 | Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
| U0003 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R. |
| U0004 | 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2)completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004)as described by cms-2020-01-r2 |
| CPT Code | CPT Short Descriptor | Vaccine/Procedure Name |
|---|---|---|
| 91300 | SARSCOV2 VAC 30MCG/0.3ML IM | Pfizer-Biontech Covid-19 Vaccine |
| 0001A | ADM SARSCOV2 30MCG/0.3ML 1ST | Pfizer-Biontech Covid-19 Vaccine Administration – First Dose |
| 0002A | ADM SARSCOV2 30MCG/0.3ML 2ND | Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose |
| 91301 | SARSCOV2 VAC 100MCG/0.5ML IM | Moderna Covid-19 Vaccine |
| 0011A | ADM SARSCOV2 100MCG/0.5ML1ST | Moderna Covid-19 Vaccine Administration – First Dose |
| 0012A | ADM SARSCOV2 100MCG/0.5ML2ND | Moderna Covid-19 Vaccine Administration – Second Dose |
Result
The MBW submitted around 70,000 claims adding up to a value of $14.5M as of 25/05
We have also collected $2.7M for the charges out of the $6m that were billed as of 30/04
Collectins to the tune of $3.5 million is anticipated for the remaining claims
60,000 patient were registered on the NCDHHS website and entered into the Unity system
40,000 patient claims were registered under the Health Resources & Service Administration Program for the Uninsured
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