Case Study: Getting Reimbursed for COVID testing of uninsured patients under HRSA program
Customer Situation
2020 challenged all healthcare clinics and institutions worldwide to partner with government bodies to treat, prevent & help eradicate covid-19. All healthcare providers and payers came together as a community and collaborated with other non-profit partners and organizations. They equipped their clinic and trained other volunteers and staff in a way that can help them offer the best healthcare possible during these unprecedented times.
Amidst these uncertainties, our client, a healthcare provider in Central Florida, had launched Covid-19 testing for both insurers and non-insured patients. Although the client got reimbursed successfully for the insured patients' claims, they were looking for a third-party RCM management company to help them submit claims electronically under the HRSA program
Challenges
Received a backlog of 1,000+ patient claims for submission under the HRSA program
Training the staff to understand the new and evolving policies for COVID test claims for insured and uninsured individuals
Acquisition of information & education on the CPTs, ICDs, and payer details from www.hrsa.gov websiteThe Providers did not provide the right level of specificity to the diagnosis codes, which adversely impacted the clean claim submission rate
Submission of clean claims and getting paid in the first submission itself is critical as the HRSA program does not consider corrected bills or late submissions and appeals
Most of the claims were already generated using a temporary ID, which is valid for 30 days from the date of service. The client had not been able to file the claims for tests performed, and many of the claims were older than three months.
Results Summary
Solution
We educated the team on the HRSA guidelines. As most of our team members worked from home, we set up a daily cadence of meetings to impart training.
The team billed the correct CPT "87635" & Dx code Z03.818 by strictly adhering to the HRSA guidelines
Correct usage of the payer name: "COVID 19 HRSA Uninsured Testing & Treatment fund" and the Insurance type: "HRSA Program."
Used the Temporary member ID as the Subscriber ID
Proper usage of the CLIA# & CLIA waive test modifier (QW)
Result
Detailed training program ensured consistent understanding of the HRSA guidelines for submitting COVID-19 testing claims
Error-free submission of over 1,000 claims worth $168K and net collections of $60K
Adherence to all IT security policies in a challenging work from home environment
Improved monthly collections from $33,242 in August by 25% i.e., $41,809.in December
Achieved targeted business outcomes and achieved a 100% client satisfaction score
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