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Reimbursements for COVID-19 Treatments & Testing of Uninsured Individuals

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Reimbursements for COVID-19 Treatments & Testing of Uninsured Individuals

In March 2020, as the entire world supported or encouraged people to stay home safely to protect them against COVID-19, health care workers & providers played a major role in controlling the outbreak.

The COVID-19 Pandemic’s Impact on Reimbursements

ReimbursementsforCOVID-19Treatments&TestingofUninsuredIndividuals

As with all other industries, healthcare providers are also facing financial challenges stemming from COVID-19. The outbreak also raised issues around the patient’s financial responsibility for paying medical bills after receiving medical care for COVID and its symptoms. The situation further worsened as healthcare providers struggled in getting due reimbursements for COVID-19 treatments, for high deductible health plans and other cost-sharing arrangements.

Government Support for COVID-19

The Trump Administration is providing support to healthcare providers in fighting the COVID-19 pandemic. The President signed several legislations including the Families First Coronavirus Response Act (FFCRA), the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA). Each of these acts was funded with over $1 billion to reimburse providers for conducting COVID-19 testing for the uninsured. Additionally, the Coronavirus Aid, Relief, and Economic Security (CARES) Act provided as much as $100 billion in relief funds to hospitals and other healthcare providers in the front line.

HRSA COVID-19 Uninsured Program and Steps to Get Reimbursed

To participate, providers should register into the HRSA COVID-19 Uninsured Program. Health care providers who have conducted COVID-19 testing or provided treatment for uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020, can request claims reimbursement through the HRSA COVID-19 Uninsured Program Portal electronically and will be reimbursed generally at Medicare rates, subject to available funding.

Getting Reimbursed Via the HRSA COVID-19 Uninsured Program

·       Enroll as a provider participant

·       Check patient eligibility

·       Submit patient information

·       Submit claims

·       Receive payment via direct deposit

Who Is Eligible?

Providers may submit claims for the uninsured by verifying and attesting that the patient does not have any US health care plans i.e., uninsured. A patient is considered to be uninsured if he does not have any individual health care plan, employer-sponsored plan, federal healthcare program, or no other payer to reimburse for COVID-19 testing and/or treatment.

What is Covered?

A comprehensive list of medical services rendered and the tests performed are covered.

  • Long-term acute care

  • Acute inpatient rehab

  • Home health

  • DME

  • Emergency ambulance transportation

  • Non-emergent patient transfers via ambulance/

Any tests were done at the following places:

  • The Office

  • Urgent care

  • Emergency room

  • Through telehealth

  • Skilled nursing facility

  • Any treatments are done as inpatient, outpatient

  •   FDA approved drugs (as they become available) for COVID-19 treatment and administered as part of an inpatient stay

  • FDA-approved vaccine

Diagnosis Codes

We provide below a list of Diagnosis codes:

2. For COVID-19 testing-related services

  • Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)

  • Z20.828 – Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)

  • Z11.59 – Encounter for screening for other viral diseases (asymptomatic)

  1. For COVID-19 treatment

    • Services have done before April 1st, 2020, should be reported as dx B97.29

    • For services on or after April 1st, 2020, the provider should report as U07.1

    • If the patient is pregnant, O98.5 should be used as the primary code and U07.1 as the secondary diagnosis code

CPT codes

  1. For Covid-19 testing-related services
    • 86318 – Immunoassay for infectious agent antibody, qualitative or semiquantitative, single-step method, e.g., reagent strip
    • 86328 – Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method, e.g., reagent strip; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
    • 86769 – Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
    • U0001 – Tests performed specifically at CDC testing laboratories
    • U0002 – supports the agency’s efforts to allow clinical laboratories outside of the CDC to create and bill for their COVID-19 tests.
  2. COVID-19 tests
    • U0001,U0002, U0003, U0004
    • 87635
  3. Antibody tests
    • 86318
    • 86328
    • 86769
  4. Specimen collection
    • G2023
    • G2024

What’s Not Covered?

The following services are not covered:

  • Services not covered by traditional Medicare will not be covered under this program.

  • Any treatment without a COVID-19 primary diagnosis, except the pregnancy case, will not be covered.

  • Hospice services

  • Outpatient prescription drugs

How Should Claims be Submitted?

Claims are submitted in 837P/I format electronically through Program-specific payer name “COVID-19 HRSA Uninsured Testing and Treatment Fund”  with payer id 95964. A specific list of clearinghouses supports the claim submission to this HRSA Covid-19 uninsured Program for uninsured individuals.

  • Clean Claim Submissions. Providers should submit clean claims to this program the very first time. Submitting interim bills, corrected claims, or late charges can’t be done or considered. Appeals for claim denials won’t be allowed.

  • Temporary Member ID for Uninsured Patients. Claims are submitted with Temporary member ID for each patient. Providers can retrieve the temporary ID through the portal at coviduninsuredclaim.linkhealth.com

  • For professional and institutional outpatient – Temporary member ID will be valid for 30 days from date of service. Eligible claims can be submitted using the temporary member ID with the date of service within the validity period.

  • For institutional inpatient – Temporary member ID is valid from the date of admission and will expire in 30 days from the date of discharge. Eligible claims can be within the validity period. For example, if the Patient has February 5, 2020, as admission date and February 25, 2020, as the discharge date, then the temporary member ID is valid till March 25, 2020. If an uninsured individual was treated in the ER before admission, use the date of admittance to the ER as the admit date.

  • Time of Filing. Claims must be submitted within 365 calendar days from date of service or admittance, and the payments are subjected as per the available funding. Claims can still be submitted after the date of validity, but the temporary member ID must be eligible for the date of service or admittance.

Reimbursement

  • Reimbursement will be based on current year Medicare fee schedule rates

  • For any new codes where a CMS published rate does not exist, claims will be held until CMS publishes corresponding reimbursement information

  • Once the claim is processed and approved for payment, the Payer will send electronic payments to the provider’s account in approximately 7-10 business days

COVID-19CPT codes

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