A Guide to Billing for COVID Recovery Services
COVID recovery clinics are a vital new part of our healthcare system, offering hope to patients with lingering symptoms. But establishing one of these clinics introduces a new layer of administrative complexity. Each service you offer, from cognitive assessments to supplemental oxygen therapy, comes with its own set of billing requirements. A small error in your medical billing process can lead to denied claims and lost revenue. Mastering the specifics of billing COVID recovery is fundamental to your clinic’s success. In this article, we’ll cover the essential information you need to align your excellent patient care with a healthy financial backend.
What Are COVID Recovery Clinics?
As the world becomes more familiar with the long-term effects of COVID-19 each and every day, so too are physicians becoming more familiar with the complications that arise for many individuals. Surprise has come, too, even for those individuals who have had mild cases of COVID-19, as even some of these individuals have found themselves experiencing complications after their initial recovery. With complete recovery being unique for every patient, COVID recovery clinics have proven their essential nature. COVID recovery clinics are being developed at a rapid pace, and providers find themselves seeking solutions to their medical billing processes. Within COVID recovery clinics, many services can be offered, each with a unique billing process that must be handled responsibly. Many facilities focus on pulmonary rehabilitation, but also offer a vast array of other services: counseling, medication, supplemental oxygen therapy, physical therapy, and a variety of other treatments depending on the severity of symptoms. Offering such a wide range of services requires high levels of communication between physicians, who necessarily work together to develop and carry out treatment plans.
The Scale of Long COVID
As our understanding of COVID-19 deepens, it’s clear that the effects don’t always end when the initial infection does. Many people experience long-term health problems after recovering, even if their first bout with the virus was mild. This condition, often called ‘long COVID,’ presents a wide range of symptoms and affects a surprisingly large number of individuals, regardless of how sick they were at first. The persistence of these issues underscores a growing need for specialized, ongoing care that addresses the unique challenges patients face long after the acute phase of the illness has passed.
Just how widespread is it? Experts estimate that around 17.6 million Americans are currently dealing with long COVID. For some, this means symptoms that linger for weeks or months, while for others, the effects can last for years, seriously impacting their daily lives. The recovery journey is different for everyone, often depending on factors like a person’s age and overall health. This variability highlights why a standardized approach to treatment just doesn’t work for these patients and why COVID recovery clinics are becoming so essential in providing personalized, comprehensive care plans.
What to Expect During a Recovery Clinic Screening
Each COVID recovery clinic has a unique screening process which patients must undergo in order to receive care. While these processes are essential for determining if a clinic is the right fit for a patient, they are even more essential for creating a treatment plan that addresses the patient’s cognitive, physical, and equipment-related needs. Listed below are a few examples of screening methods used by COVID recovery clinics:
- Recency of positive COVID-19 test results
- Presence of COVID-19 antibodies
- Pulmonary Functioning Screen
- Rehabilitation Needs Screen
- Stamina Screen
- Cognitive Assessment
The majority of these assessments are regular practice for many physicians and remain within the general scope of practice. However, testing directly related to COVID-19 and the presence of antibodies brings new challenges, particularly into the medical billing process.
Navigating Billing After the Public Health Emergency (PHE)
The end of the Public Health Emergency (PHE) brought significant changes to the healthcare landscape, particularly in how services are billed and covered. For providers, staying current on these shifts is essential for maintaining a healthy revenue cycle and providing clear guidance to patients. The rules that governed billing for COVID-19 testing, treatment, and telehealth services have evolved, creating new challenges for practices. Understanding these new policies is the first step toward ensuring your claims are processed correctly and your patients aren’t caught off guard by unexpected costs. This requires a proactive approach to verifying insurance, communicating with patients, and updating your internal billing protocols to reflect the new normal.
Changes to Patient Costs and Insurance Coverage
During the PHE, many patients became accustomed to free COVID-19 testing and treatment. That is no longer the case. For most individuals, including those with Medicare, Medicaid, or private insurance, cost-sharing responsibilities like co-pays and deductibles now apply to at-home tests, testing services, and COVID-19 treatments. This shift directly impacts your practice’s front-end operations, as staff must now diligently collect patient financial responsibility at the time of service. It also places a greater emphasis on accurate medical billing and coding to ensure claims correctly reflect patient liabilities and are submitted cleanly to payers, reducing the risk of denials related to coverage changes.
Advising Patients on Unexpected Bills
Clear communication is your best tool for helping patients manage the transition. Many patients may be confused when they receive a bill for services they thought were fully covered. It’s helpful to explain that even when federal guidelines intended to prevent patient billing for certain services, the hospital or clinic still needs to submit a claim to their insurance for reimbursement. Sometimes, a payer’s interpretation of the rules can differ, leading to a bill being sent to the patient. Proactively discussing potential costs, verifying insurance benefits before appointments, and providing clear statements can help manage patient expectations and reduce confusion, preserving the trust you’ve built with them.
The “Medicaid Unwinding” and Its Impact
One of the most significant consequences of the PHE’s conclusion is the “Medicaid unwinding.” Throughout the pandemic, states received additional federal funding to maintain continuous enrollment for Medicaid recipients. As this provision has ended, millions of individuals are at risk of losing their Medicaid or CHIP coverage. For your practice, this means you may see a sharp increase in uninsured or underinsured patients. This makes front-end eligibility verification more critical than ever. A robust healthcare revenue cycle management strategy is vital to get ahead of this issue, identify patients who have lost coverage, and work with them on alternative payment options to protect both the patient and your practice’s financial stability.
Updated Telehealth Billing Policies
Telehealth was a lifeline during the PHE, and while some flexibilities have been made permanent, others have changed. Fortunately, many of the key telehealth provisions for emergency medicine have been extended. Providers can continue to bill for telehealth services using standard in-person evaluation and management (E/M) codes, including ED visit codes (99281-99285) and critical care codes (99291, 99292). However, these policies are subject to change, and payer-specific rules can vary. Staying on top of these updates is crucial, especially for specialties like urgent care and behavioral health that rely heavily on virtual visits. A dedicated billing partner can help ensure your practice remains compliant and properly reimbursed for all telehealth services rendered.
Billing for High-Throughput COVID Testing
As a greater understanding of SARS-CoV-2 is developed, so too is the process for billing related services, particularly high-throughput testing. As of April 2, 2020, the following CPT codes for high-throughput COVID testing went into effect:
U0003
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
U0004
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. Understanding how to apply these CPT codes to your practice is a critical component in providing quality care. Additionally, these new standards are essential in the day to day operations of your facility and your ability to maintain your Revenue Cycle Management. For more information on COVID-19 billing and codes, click here.
Additional Billing Codes for COVID-19 Care
Beyond the codes for high-throughput testing, your practice will likely encounter other common scenarios related to COVID-19 care. Correctly billing for services like rapid antigen tests and vaccine administration is fundamental to maintaining a healthy revenue stream. Using the right codes from the start helps prevent claim denials and delays, ensuring you are properly compensated for the vital care you provide to your community. Let’s look at a few of the most important codes you should know.
Rapid Antigen Test Codes (87811, 87426, 87428)
When your team conducts a rapid antigen COVID-19 test within your office, specific CPT codes apply. Professional providers should submit claims using 87811, 87426, or 87428, depending on the specifics of the test performed. These codes are designated for tests rendered in a professional setting, like a physician’s office or urgent care clinic. Ensuring your billing team uses the appropriate code for each test is a small but critical detail in your overall healthcare revenue cycle management strategy, as it directly impacts reimbursement accuracy.
Vaccine Administration Code (90480)
The act of administering the COVID-19 vaccine is billed separately from the vaccine product itself, which is typically provided by the government at no cost. The primary CPT code for the administration of a COVID-19 vaccine is 90480. This code should be used for each dose your practice administers. It compensates your practice for the clinical labor, time, and resources involved in the vaccination process, from patient screening to the post-injection observation period. Proper use of this code is essential for getting paid for your role in the public vaccination effort.
In-Home Vaccine Administration Code (M0201)
Recognizing that some patients cannot easily travel to a clinic, many providers have offered in-home vaccinations. To compensate for the additional resources required for these visits, there is a specific HCPCS Level II code available. Use code M0201 to bill for the additional payment when you administer a COVID-19 vaccine in a patient’s home. This code is intended to be billed alongside the standard vaccine administration code (90480) to cover the logistical costs associated with providing care outside of your office walls.
Reimbursement for COVID-19 Vaccines and Treatments
Applying the correct codes is the first step, but understanding the associated reimbursement rules is just as important for your practice’s financial stability. Payment policies for COVID-19 vaccines and treatments come with specific guidelines, particularly around what can be charged to patients and how different payers, like Medicare, handle reimbursement. Staying informed about these rules helps you manage patient expectations, maintain compliance, and ensure your practice receives the full payment it has earned for its services. A well-managed revenue cycle administration process is key to handling these complexities.
Vaccine and Monoclonal Antibody Payment Rules
One of the most important rules for providers is that patients should face no out-of-pocket costs for receiving a COVID-19 vaccine. This means you cannot bill patients for the vaccine itself or for any associated administration fees, copays, or coinsurance. This federal mandate was designed to make vaccination as accessible as possible. Your front-office and billing staff must be fully aware of this rule to prevent billing errors and ensure a positive, transparent experience for your patients.
Specific Medicare Billing Requirements
For practices that serve the Medicare population, reimbursement rates for vaccine administration have been clearly defined but have also changed over time. For instance, Medicare paid providers approximately $40 for each COVID-19 vaccine dose administered through the end of 2023. Beginning in 2024, that rate was adjusted to around $30 per dose. Keeping up with these date-sensitive payment adjustments is crucial for accurate claims submission and revenue forecasting. An expert medical billing partner can help your practice manage these evolving payer rules seamlessly.
Resources for Uninsured Patients
Providing care to uninsured patients can present financial challenges, but resources are available to ensure you get paid for COVID-19 services. The HRSA COVID-19 Coverage Assistance Fund was created to reimburse healthcare providers for testing and treating uninsured individuals for COVID-19. Knowing how to submit claims through this program allows you to provide essential care to everyone in your community, regardless of their insurance status, without having to absorb the cost of that care yourself.
Why Outsource Your Medical Billing?
Outsourced medical billing for COVID recovery clinics will play a vital role in the quality of treatment that patients receive. The rapid increase in the demand for such clinics presents physicians with a tighter schedule, sometimes requiring the prioritization of quality of care over best medical billing processes. By outsourcing your COVID recovery clinic billing, your clinic will be able to focus its time and energy where it is most desired – your patients.
Outsourced medical billing:
- Allows your staff to engage in more patient care activities and allocate more time to compassionate care.
- Saves money on hardware and software costs associated with your newly designated facilities.
- Provides seamless data transfer.
- Reduces the risk of billing and coding errors.
How Med USA Supports COVID Recovery Clinics
At Med USA, we understand the value of patient care and the intimate relationship that quality of care has with your medical billing process. COVID recovery clinics are not your typical clinic; they are preventative and thoughtful in ways that no one could foresee. Your billing processes should be just as forward thinking. Med USA is one of the most successful medical billing companies operating in the United States. For more than 40 years, we have assisted over 2,500 clients by providing top-tier medical billing services with a retention rate of over 97%. Our partners are provided with dedicated Account Managers, individuals who care deeply about the success of your clinic and the recovery of your patients.
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Frequently Asked Questions
What is the biggest billing change I need to know about now that the Public Health Emergency is over? The most significant change is the return of patient cost-sharing. During the emergency period, many COVID-related tests and treatments were provided at no cost to patients. Now, standard co-pays, deductibles, and coinsurance apply for most people with private insurance, Medicare, or Medicaid. This makes it essential for your front-office staff to verify insurance benefits and collect patient payments at the time of service.
How can I best explain unexpected COVID-related bills to my patients? Clear and proactive communication is your best approach. Many patients grew accustomed to not paying for COVID services, so a bill can be confusing. You can explain that standard insurance rules are back in effect and that your clinic is required to submit a claim to their insurance provider. Sometimes, how an insurer processes that claim results in a balance. Discussing potential costs and verifying benefits before an appointment helps manage expectations and maintain trust.
Why is billing for a COVID recovery clinic more complex than for other specialties? COVID recovery clinics are unique because they integrate care from multiple specialties to create a single, comprehensive treatment plan for each patient. This often includes services like pulmonary rehabilitation, physical therapy, cognitive assessments, and counseling. Each of these services comes with its own set of billing codes and payer rules, creating a complicated web of requirements that must be managed perfectly to ensure a claim is paid correctly.
What happens if a patient lost their Medicaid coverage after the “unwinding”? The end of continuous Medicaid enrollment means you may have more patients who are uninsured without realizing it. This makes verifying eligibility before every single visit more critical than ever. If a patient has lost their coverage, you can no longer bill Medicaid for their services. A strong revenue cycle process is vital for identifying these patients early, so you can discuss alternative payment options and protect your practice from unexpected financial losses.
What’s the primary advantage of outsourcing billing for a new COVID recovery clinic? The main benefit is that it frees up your team to concentrate on what matters most: patient care. Long COVID is a new and complex condition, and your clinical staff’s energy is best spent developing treatment plans, not wrestling with changing billing codes. Outsourcing to a dedicated partner ensures your claims are handled accurately by experts from day one, which reduces errors, improves cash flow, and lets you focus on your patients’ recovery.
Key Takeaways
- Prepare for new patient financial responsibilities: With the end of the Public Health Emergency, patients now have co-pays and deductibles for COVID services, so your front office must verify insurance and clearly communicate potential costs to avoid surprise bills.
- Master the specific codes for COVID care: Proper reimbursement requires using the correct CPT and HCPCS codes for everything from high-throughput tests and vaccine administration to telehealth visits and in-home services.
- Consider outsourcing to handle billing complexity: The rules for billing COVID recovery services are constantly changing; partnering with a billing expert ensures compliance and accurate payments, allowing your clinical team to focus entirely on patient treatment.
