The federally declared public health emergency (PHE), set to expire on October 23, was renewed and will remain due to the continued impact of the COVID-19 pandemic. The more relaxed regulatory rules regarding Medicare and Medicaid compliance associated with the PHE is no more, as healthcare provider’s ramp up preparedness with focus on internal processes. 

​In the early stages of the pandemic, CMS guidance indicated that a provider's documentation was sufficient to receive reimbursement from payers. The 20‐percent higher Medicare reimbursement for inpatient COVID treatment and a positive test result was not necessary. However, effective September 1, 2020, CMS has enlisted a mandate requiring hospitals to have positive COVID‐19 laboratory tests in patients' records to qualify for Medicare's 20‐percent add‐on payment. Suffice it to say, ensuring appropriate reimbursement for COVID-19 claims require careful management and attention to detail. 

Though the response has been swift, when the virus first emerged, there were no specific codes or guidelines set and no process to document testing accurately. We now have designated diagnoses codes and guidelines for COVID-19, but bringing coding teams up to speed will require diligence. The COVID-19 billing considerations are even more complex.

Recently, congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provides more than $100 billion in direct aid to hospitals and other providers. This includes a 20 percent increase in reimbursement for inpatient COVID-19 claims.  

April welcomes the anticipation of spring and its promise of renewal. It is also the month for us to recognize the importance of our ability to volunteer and give back to our communities. However, this year the volunteer landscape is quite different than years past. The current environment can leave one asking the question ─ What can one do at a local or global level when in isolation? 

As of March 27, 2020, there have been more than a half a milion confirmed cases of COVID-19, including nearly 90,000 in the U.S. alone. As numbers of new cases continue to grow, the U.S. Centers for Disease Control and Prevention (CDC) expands their recommendations of social distancing for containment measures, increasingly disrupting daily life, and ultimately the livelihood of many individuals. 

The situation has now reached the point where public health officials are encouraging and in some regions requiring people to stay home. As a result, Telehealth Services have dramatically increased, becoming critical in caring for patients as the COVID-19 pandemic swiftly evolves. ​

Hierarchical Coding Categories (HCC) is becoming a common term as healthcare continues to move toward an “outcomes” based model. Understanding the acronym T.O.A.D is of utmost importance. 

The healthcare industry is facing many obstacles in the coming year that pose new challenges to healthcare organizations. With new government regulations, advancements in technology, and savvier, well-informed patients, the landscape for 2020 looks to bring many changes.  
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Axea Solutions examined recent rulings and emerging issues and spoke with clients to determine areas that healthcare facilities will be focusing efforts in 2020. While there are far greater than five areas of focus, these are the top five significant concerns we determined to pose the most challenges and to have the highest impact on the healthcare industry in the coming year.