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COVID-19 Medical Claims. What You Should Know.

It is hard to find someone in our current world who is not aware of COVID-19. The entire world was affected by the global coronavirus pandemic and it has been a source of dispute and chaos all while medical researchers and healthcare workers have desperately tried to keep up. When dealing with a health crisis of such a massive scale, it is important that everyone be knowledgeable about keeping safe. For healthcare providers, properly filing COVID-19 medical claims can maintain smooth operations and better patient experiences.   

In this article, we speak directly to healthcare professionals and billers submitting claims related to COVID-19. In order to better care for patients and increase the speed in which we do so, properly processing COVID-19 medical claims is essential. Contact us to learn more about how a claims clearinghouse like Apex EDI can help keep your workflow, patient care, and revenue stream stable during the COVID-19 pandemic.  

Enlisting the help of claims clearinghouse is one of the best ways billers can tackle the challenges of COVID-19 medical claims.
Enlisting the help of claims clearinghouse is one of the best ways billers can tackle the challenges of COVID-19 medical claims.


Symptoms of COVID-19

Common symptoms of COVID 19 are listed below. It is important to note that each patient can present with varying levels of symptom severity. Some may even be asymptomatic and present with no symptoms while carrying the virus.  

  • Fever or chills 
  • Cough 
  • Shortness of breath or difficulty breathing 
  • Fatigue 
  • Muscle or body aches 
  • Headache 
  • New loss of taste or smell 
  • Sore throat 
  • Congestion or runny nose 
  • Nausea or vomiting 
  • Diarrhea 

      This list does not include all possible symptoms, and to present with one or a combination of these symptoms does not equal a definitive COVID-19 diagnosis without proper testing. The CDC advises the public and practitioners stay up-to-date on coronavirus symptoms in order to best provide patient care.  

      People at Risk 

      COVID-19 poses a higher threat to older adults, especially those living in nursing homes or other long-term care facilities, as they are living in closer proximity to other high-risk individuals. Those with underlying conditions (such as heart or lung diseases and diabetes) can also be more harshly affected by COVID-19.  

      As of February 2021, the CDC has found that pregnant woman are at an increased risk of illness from COVID-19, which can also contribute to other maladies such as preterm birth. Along with those with underlying conditions or other circumstances that require it, pregnant woman still must attend hospital or clinic appointments which could increase their exposure opportunities. Minimizing contact is key in the era of COVID, even for essential functions like medical care. 

      Thankfully, telehealth technology has allowed many to continue receiving care. If telehealth claims are also part of your practice during the COVID-19 pandemic, read our guide on how to maximize telehealth billing.  

      Other conditions can also contribute to an individual’s risks for exposure and the severity of their symptoms. Such conditions include but are not limited to homelessness, substance abuse, disabilities, or living in a rural area. These factors are part of a larger interplay which means someone could be less educated about the virus or not have the funds, ability, or agency to protect themselves or seek treatment. 

      COVID-19 Testing and Diagnosis 

      COVID-19 is diagnosed through viral testing. A viral test can only confirm if a patient is currently infected. Blood antibody testing is required to determine whether someone was previously infected with the virus. Certain cases have shown it is possible for someone to be re-infected with the COVID-19 virus.  If someone is presenting with Coronavirus symptoms or has recently been in a situation which increases their risk for exposure (such as a family gathering or work trip), they should seek testing and communicate this information with their doctor as well as the professionals at the testing site.  

      Per the Department of Health and Human Services, The Families First Coronavirus Response Act ensures that COVID-19 testing is free to anyone in the U.S., including the uninsured.

      A female doctor administering a COVID-19 viral test with a nasal swab.
      In the midst of a global pandemic, practitioners and billers must know how to accurately submit a COVID-19 medical claim.


      Treatment and Vaccination

      Most otherwise healthy people who are sick with COVID-19 can recover safely at home. These patients are required to self-quarantine and monitor their symptoms per their healthcare provider and local health department. Should symptoms become more severe, patients should seek emergency medical care. The National Institute of Health (NIH) has compiled and regularly updates their Treatment Guidelines for healthcare workers and doctors. This includes what drugs and under what circumstances may be used under Emergency Use Authorizations or EUAs. Furthermore, depending on each individual patient, healthcare providers will have to monitor and treat any other maladies brought on or made worse by the virus, such as pneumonia.

      In early Spring of 2021, COVID-19 vaccines were made more accessible to the public. Vaccine doses purchased by the government with taxpayer dollars will be free regardless of insurance coverage or manufacturer, and it is estimated that once the crisis has abated the vaccine will be covered similarly to the flu vaccine. Note, this does not mean that all vaccine doses in the future will fall under the same guidelines. As of now, no surprise billing and balance billing are not allowed when it comes to the COVID vaccine, so in-network providers are not required for vaccine administration. Where patients may find themselves charged for services is with vaccine service fees for administering the dose or for a doctor’s visit itself. 

      Doctor or nurse giving a patient their dose of the COVID-19 vaccine.
      As of now, the public doesn’t need to be concerned about the cost of COVID-19 vaccines. But they may be billed for service charges and doctor’s visits.

      Coding for COVID-19 

      COVID-19-related claims should be submitted per the CDC’s ICD-10 CM diagnostic codes. Due to the ever-changing nature of the COVID-19 pandemic and thus the always influx COVID-19 claims processing procedures, healthcare practitioners and billers should consult the CDC when filing. Those resources can be found here on the up-to-date CDC website.  

      Third party payers, too, are constantly adjusting coverage to meet the needs of patients during this public health crisis. To best be on top of these shifting coverages, trust your claims management to a clearinghouse that always has their finger on the pulse of insurance billing. 

      Like all other claims, when submitting COVID-19 claims, it is absolutely imperative to submit polished, timely, and accurate claims. Failure to do so could result not only in delayed revenue but in delayed treatment. Consider enlisting a claims clearinghouse like Apex EDI for your EHR or medical practice to be better prepared for COVID-19 claims processing and keep your practice moving.   

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