Insights

New Law Impacts COVID-Related Reimbursement

Jan 6, 2021 9:15:00 AM / by Aspirion

Near the end of 2020, New Jersey Governor Phil Murphy signed Senate Bill 2380 into law, establishing that essential workers’ contraction of COVID-19 during the Public Health Emergency is considered work-related and fully compensable for the purposes of workers’ compensation. This law applies to any individuals who contract COVID-19 while working as essential employees at a workplace other than their own residence. New Jersey is the first state to enact this type of legislation; however, as essential workers continue serving their communities and putting themselves at risk, other states are likely to follow the trend.

As a result of the new legislation, hospital billing departments must bill the workers’ compensation plans of essential workers, rather than their health insurance. Since the law is retroactive back to March 9, 2020, many facilities are in the process of implementing an intensive three-step process for admitting new patients and reviewing past claims:

1. Establish key questions in the admission/registration departments. Examples include:
  • “Are you considered an essential employee?”
  • “Do you work in an environment outside your own home?”
  • “Please share your workers’ compensation insurance information.”
Employment information obtained by admitting/registration is often unreliable, so patient access teams must be fully informed on the tactics that will engage patients and collect data effectively. Here are some of our tips for ensuring successful interactions with patients.

2. Review all paid claims back to March 9, 2020 with COVID-19 diagnoses to determine:
  • Is COVID-19 the primary diagnosis?
  • Did the health insurance pay the claim in full?
  • Has the health insurance taken steps to recap their payment?
  • If the patient was uninsured, did the hospital submit the claim and receive reimbursement from HRSA? 

3. Establish a procedure for accounts that qualify in #2 by:

  • Contacting patients to determine if they worked outside the home in an essential capacity at the time of diagnosis.
  • Ensuring and monitoring refunds of health insurance payments and any deductible and copay/coinsurance payments.
  • Ensuring and monitoring refunds to HRSA.
  • Requesting workers’ compensation insurance information from the patient.
  • Billing the workers’ compensation for the hospitalization.

Reviewing paid claims and establishing new processes can be time-intensive, requiring excessive labor from your team. If your RCM staff is stretched too thin, reach out to our experts.

We’ll evaluate your claims, make the necessary corrections, and ensure successful reimbursement—all without you having to lift a finger.

Tags: Reimbursement, Workers' Compensation, COVID-19

Aspirion

Written by Aspirion

Since 2008, Aspirion has offered a growing array of RCM services for hospital, physcian group, and provider systems looking for better results in managing their most complex reimbursements. Aspirion has been and continues to be a trusted partner to many of the most prominent providers in the U.S.