Payers are reimbursing providers for all COVID-19-related testing and treatment they are furnishing to their insured members, but what if the patient is uninsured?
Healthcare providers need not write off COVID-19 testing and treatment services rendered to uninsured patients. Compensation is available!
The public health emergency for COVID-19 requires the healthcare industry to focus their efforts on treating patients and testing individuals for COVID-19 and, until recently, ceasing all “non-essential” services. As a result, healthcare providers are losing significant revenue this year.
Recognizing this, Congress has passed various legislation this year that allows the U.S. Department of Health and Human Services (HHS) to reimburses providers for COVID-19-related services furnished to the uninsured.
Providers who conduct COVID-19 testing or provide treatment for uninsured patients with a COVID-19 diagnosis on or after Feb. 4, 2020, can e-file claims for reimbursement via the COVID-19 Uninsured Program Portal.
What is the COVID-19 Uninsured Program Portal?
The COVID-19 Uninsured Program portal is being administered by UnitedHealth Group through a contract with the HHS Health Resources and Services Administration (HRSA). The program is being funded by the Families First Coronavirus Response Act and the Paycheck Protection Program and Health Care Enhancement Act, which each appropriate $1 billion to reimburse providers for conducting COVID-19 testing for the uninsured. A portion of the funding appropriated in the Provider Relief Fund will be used to support expenses related to the treatment of uninsured individuals diagnosed with COVID-19.
What COVID-19 Services Are Reimbursable?
Providers can receive reimbursement for providing the following COVID-19-releated services to uninsured patients:
- Specimen collection, diagnostic and antibody testing
- Testing-related visits provided in office/telehealth, urgent care, or emergency room settings
- Treatment (in most settings, including telehealth)
- FDA-approved vaccine (once available)
Services not covered by traditional Medicare are not reimbursable. Also not covered for payment under the COVID-19 Uninsured Program:
- Any treatment without a COVID-19 primary diagnosis (except for pregnancy O98.5-, when a COVID-19 diagnosis may be secondary)
- Hospice services
- Outpatient prescription drugs
All claims are final. The Centers for Medicare & Medicaid Services (CMS) will not accept interim bills, corrected claims, late charges, voided claims transactions, or appeals via the COVID-19 Uninsured Program Portal.
How Do Providers File COVID-19 Claims for the Uninsured?
To participate, providers must attest during registration that they have confirmed the patients were in fact uninsured and no other payer will reimburse them for the services. For example, individuals who are enrolled in a state’s Medicaid program, or have coverage for treatment services through the COVID-19 testing eligibility group, are not uninsured for the purposes of this HRSA-administered program.
- Enroll as a provider participant on the HRSA COVID-19 Uninsured Program Portal.
- Validate Taxpayer Identification Number
- Set up Optum Pay™ ACH for direct deposit
- Add provider roster
- Check patient eligibility
- Submit patient information
- Add and attest to patient roster
- Submit claims electronically for professional and facility services using the ANSI X12 837 and Payer ID 95964
Note: THE HRSA COVID-19 Uninsured Program uses a unique version of Smart Edits to detect claims with potential errors. Repaired claims should be sent with the original frequency code of 1, not with a replacement or voided claim indicator of 7 or 8. Providers will receive payment via direct deposit. For any new codes where a Medicare published rate does not exist, claims will be held until CMS publishes corresponding reimbursement information.
Providers must accept the program reimbursement as payment in full and agree not to balance bill the patient. Payments will be “generally at Medicare rates,” according to the HRSA.
Take note: Providers may be subject to post-reimbursement audits.
How Do I Code COVID-19 Testing and Treatment Claims?
For confirmed COVID-19, use ICD-10-CM code B97.29 Other coronavirus as the cause of diseases classified elsewhere as the primary diagnosis (or secondary diagnosis, when pregnancy is the primary diagnosis) in applicable claims with dates of service between Feb. 4, 2020, and April 1, 2020. For claims with dates of service on or after April 1, 2020, use U07.1 COVID-19.
For diagnostic testing and testing-related services performed in an office, urgent care or emergency room, labs, or via telehealth, report, as appropriate:
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)
For more information about the COVID-19 Uninsured Program, go to the HRSA webpage for COVID-19 Claims Reimbursement. Once registered, providers can sign in to the HRSA COVID-19 Uninsured Program Portal and follow the directions for electronic claims submission.
Claims are subject to Medicare timely filing requirements, and reimbursement is subject to available funding, so don’t delay!