AHIP and HFMA work together to offer billing guidance for COVID-19 outpatient services at alternate care sites

Improving access to COVID-19 testing remains a national priority as the United States moves through the novel coronavirus pandemic. Toward that end, hospitals, health systems, physicians and health insurance providers are working together to help ensure that billing for COVID-19 testing and treatment reflects accurate coding and other technical information, including patient cost-sharing waivers. As part of this ongoing partnership, America’s Health Insurance Plans (AHIP) and the Healthcare Financial Management Association (HFMA) have come together to offer voluntary guidance for how care providers should code and bill COVID-19 care delivered in alternate outpatient settings. By adopting these coding practices, health systems and health insurance providers alike can improve the speed and accuracy of payment as well as reduce administrative burden, turning more resources to caring for patients. 

Click here to download the voluntary billing guidance for outpatient services.

Throughout the COVID-19 crisis, health systems have been innovative in making the best use of resources to care for every patient. Alternate care sites, such as drive-up/walk-up testing sites, have been essential to this response, providing safe and easily accessible care options for consumers.  

New diagnosis and billing codes have been introduced to capture this activity and ensure proper payment. But clinicians and health insurance providers are struggling to keep up with seemingly constant changes in how they are expected to bill and adjudicate claims. This new resource is designed to provide clear and concise guidance for providers to code and bill, and health insurance providers to pay, for services rendered in temporary, alternate sites during the COVID-19 crisis.

While voluntary, this guidance reflects some legal requirements of the Medicare program, as well as laws such as the Health Insurance Portability and Accountability Act (HIPAA) and the Families First Coronavirus Response Act (CARES Act).

AHIP and HFMA previously developed voluntary billing guidance for inpatient services, which can be found here. 

For more information on what health insurance providers are doing to overcome the coronavirus crisis, visit AHIP’s website.

For additional resources on COVID-19, visit HFMA’s website. 

About HFMA

The Healthcare Financial Management Association (HFMA) equips its more than 56,000 members nationwide to navigate a complex healthcare landscape. Finance professionals in the full range of work settings, including hospitals, health systems, physician practices and health plans, trust HFMA to provide the guidance and tools to help them lead their organizations, and the industry, forward. HFMA is a not-for-profit, nonpartisan organization that advances healthcare by collaborating with other key stakeholders to address industry challenges and providing guidance, education, practical tools and solutions, and thought leadership. We lead the financial management of healthcare.

About AHIP

AHIP is the national association whose members provide coverage for health care and related services to hundreds of millions of Americans every day. Through these offerings, we improve and protect the health and financial security of consumers, families, businesses, communities and the nation. We are committed to market-based solutions and public-private partnerships that improve affordability, value, access, and well-being for consumers. Visit www.ahip.org for more information.