The Impact of New Diseases on Medical Billing and Coding

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By DeVry University

December 09, 2021
6 min read

For the most part, medical billing and coding professionals can rely on the International Classification of Diseases (ICD) database established by the World Health Organization (WHO) to assign diagnostic codes to patient records and submit insurance claims.

But what happens when a new disease, such as COVID-19, suddenly appears and affects many patients? How do you navigate coding and billing when an ICD code hasn't been assigned to a new condition?

Let's look at the impact of new diseases on medical billing and coding and how you and your organization can handle these circumstances.

How New Diseases Impact Medical Billing and Coding

New diseases can impact medical billing and coding on many fronts. Here are some key areas you should know:

New Diagnostic Codes

In the case of COVID-19, the Centers for Disease Control (CDC) and the American Medical Association (AMA) responded quickly with new billing codes. The CDC added new codes to ICD-10 in April 2020 to address COVID-19-related conditions, and the AMA announced a new Current Procedural Terminology (CPT) code for COVID testing.

The CDC, AMA, etc. are likely to respond to a widespread new disease quickly. They'd add new codes to ICD and CPT to minimize issues providers may encounter during the claim process to ensure the stability of the healthcare system. But what happens if a new disease is less common?

The public and private sectors can request new or revised ICD-10-PCS procedure codes by submitting a recommendation to the ICD-10 Coordination and Maintenance (C&M) Committee. After the proposal is reviewed in a C&M meeting, the Department of Health and Human Services will make the final decision.

Recent changes in evaluation and management (E/M) coding mean that physicians can select an E/M code based on time spent on a patient encounter or medical decision-making process without relying on a patient’s history or physical exam. This can provide more flexibility when dealing with a new disease where there are few precedents.

Professional organizations, such as The American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA), offer many resources to help members keep current with medical billing and coding practices. You can subscribe to their communications to get updates on codes related to new diseases.

Care Delivery and Documentation

New diseases often require new treatments or different ways to deliver care. Medical billers and coders must stay up-to-date with these approaches to ensure that they use the correct codes and have the appropriate documentation required by payers, especially for new procedures.

In the case of COVID-19, the contagious disease also changed how other patients receive care. The rise of telehealth and virtual care require different methods of documentation to support medical coding. For example, a team of coding educators developed a grid to address various patient communication methods and the corresponding documentation and attestation required by payers.

Medical billing and coding teams should share such guidelines in a centralized location so every staff member can access the latest information to improve the accuracy and efficiency of the claim process.

Claim Submission

At the onset of a new disease, such as COVID-19, medical billing and coding professionals may need to adjust their billing and payment tracking to accommodate an overwhelmed healthcare system. Without a standard procedure for coding the disease and treatment, medical billers have to spend more time negotiating with insurance companies to get claims approved.

The high level of uncertainty often leads to an increased number of denied claims, which can cost as much as $25 each to correct. Besides ensuring the accuracy of the submissions, you can minimize denied claims by analyzing the details of similar cases to see where the errors occur. Then, apply the understanding to future claims.

Different payers may have different ways of handling claims associated with new diseases as everyone is trying to figure out the best way forward. Organizations can use an automated revenue management tool to develop custom edits for each payer to ensure that they're using the appropriate codes for each submission and minimize the number of denied claims.

Patient Invoicing

The higher number of denied claims associated with new diseases means more work is needed to invoice patients, explain the charges, and follow up on payments. Since there's no precedent on how to record the disease and the related treatments, healthcare organizations may have to come up with new standards and processes when generating patient statements.

New diseases often cause financial and emotional distress to patients. Medical billers may have to spend more time to understand their circumstances and devise payment plans to help alleviate the situation while ensuring that the healthcare provider will receive the revenue.

The various soft skills for medical coding and billing are even more critical [ LINK TO SOFT SKILL POST ] in these circumstances. These include communication skills, active listening, problem-solving skills, empathy and more. Medical billers and coders must be agile and resourceful to help everyone involved navigate the situation.

Surprise Medical Billing and Patient Disputes

During COVID-19, stories of surprise medical billing made the news. For example, many patients don’t expect surcharges, such as those for personal protective equipment (PPE.) New and unfamiliar charges often cause more patient disputes and late or even non-payment. Medical billers have to field more of these inquiries about patient invoices, which significantly increases their workload.

Meanwhile, many states have taken action to protect patients from surprise medical bills for treatments provided during the pandemic. For example, COVID-19 patients in Connecticut treated by an out-of-network provider must be billed as in-network.

Medical billers and coders must stay current with the latest rules and regulations, especially when a new disease creates an emergency. Following the latest guidelines can help minimize patient disputes, facilitate claim processes and ensure that healthcare organizations can collect payments on time to improve cash flow during uncertain times.

Revenue Cycle Management

A new disease, especially a highly contagious one like COVID-19, can deter patients from seeking treatments for other conditions. This can throw off the regular patient load for a healthcare facility and impact its revenue forecast.

If you handle financial reporting, you may need to pay special attention to how the fluctuation in revenue impacts other financial operations, such as budget and forecasting. You may also have to revisit your invoicing and follow-up process to get more claims and patient statements paid on time.

The use of new technologies, such as practice management solutions and computer-assisted coding solutions, can help facilitate revenue cycle management. When the U.S. switches over the ICD-11 in 2022, the database can integrate with various healthcare management platforms so new codes related to a new disease can be applied promptly.

Prepare For a Career in Medical Billing and Coding at DeVry

COVID-19 has highlighted the need for experienced and skillful professionals who can navigate the impact of new diseases on medical billing and coding. If you’re thinking about a career in medical billing and coding, DeVry can help. Take your first step with our Undergraduate Certificate in Medical Billing and Coding, to help you build a solid foundation from our industry-experienced faculty. Classes start every 8 weeks.

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