Coding Challenges for Newly Discovered Lab Tests and Conditions

When a new disease or condition is discovered, the focus is on detecting the disease and caring for patients who have the disease. Behind the scenes, billing codes need to be established in order to have specific codes for the newfound laboratory tests and conditions. CMS and the third-party payors typically scramble to define the disease, as well as its signs and symptoms. While the new diseases are being tracked in patients, behind the scenes the payors are setting set up new codes and billing rules so the providers can be paid for the services performed.

CMS and other payors also have to set up a system where the data on patients with coronavirus can be easily tracked. Just last week, CMS had to come up with new codes for the lab tests performed to detect COVID-19 (coronavirus) in patients. CMS also developed a second Healthcare Common Procedure Coding System (HCPCS) code to be used by laboratories to bill for certain COVID-19 diagnostic tests and to help increase COVID-19 testing while tracking all of the new cases.

FairCode is an expert at specificity in coding which is achieved by combining the domain expertise of experienced physicians with modern data science and analytics technologies to increase hospital revenue. FairCode bridges the gap between a hospital’s attending physicians and hospital coders. The result? Patient acuity and Case Mix Index are more accurately captured with the correct DRG, and hospital reimbursements adjust accordingly. DRG Validation and physician conducted medical chart reviews happen in real time, significantly impacting hospital quality rankings, case mix index (CMI) and bottom-line results. From clinical validation and chart reviews to payor denial defense, FairCode’s physicians and data scientists are part of a hospital’s coding team. Add FairCode to your existing CDI initiatives and see the difference. Outcomes are measurable and significant. FairCode averages greater than 4:1 Gross Return on Investment.

http://www.faircode.com/