COVID dx suspected confirmed

heartyoga

Guru
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Cookeville
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We have a biller that believes that everyone we bill has to be checked for COVID bec insurance will pay fully (deductible and copay) if there is a dx of covid suspected/confirmed. She goes into the hospital system looking at the labs to check for COVID dx. We had warned her that it would be a HIPAA issue.

She insists that we are helping the patients if they are suspected/confirmed COVID then no copays/deductibles.

We deal mostly with cardiac patients and we feel there is no need to be searching for COVID dx for fear of HIPAA violation.
 

ndanh01

Networker
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Federal Way, WA
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When the patient comes in to see the provider, what is the reason the patient is coming in for? That is what should be coded. Accessing the patients medical record in the hospital is not a HIPAA violation if you need access for billing/coding/payment/continuation of care purposes. However, with that being said, going into a pt's chart to find the COVID19 dx to submit for the ded/co-pay to be waved is fraudulent. There are certain guidelines that have to be followed when assigning a dx.

With the pandemic going your providers should be documenting in their chart notes the results of the COVID19 screening.
 
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