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Healthcare providers can request payment for COVID-19 testing and treatment of uninsured

published in McAfee & Taft LINC | May 7, 2020

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), launched a COVID-19 Uninsured Program Portal.  The new portal allows healthcare providers who have conducted COVID-19 testing of uninsured individuals or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020, to submit claims for reimbursement.

Although eligible providers could begin enrolling in the COVID-19 Uninsured Program on April 27, 2020, the program only began accepting claims for reimbursement on May 6, 2020.  The earliest healthcare providers can expect to receive payment is  May 18, 2020.

Healthcare providers will be reimbursed generally at Medicare rates, subject to available funding.  The portal is available here.

The steps in utilizing the COVID-19 Uninsured Program Portal include: (1) enrolling as a provider participant, (2) checking patient eligibility, (3) submitting patient information, (4) submitting claims, and (5) receiving payment via direct deposit.

Covered and excluded services

Under the program, reimbursement will be made for qualifying testing for COVID-19 and treatment services with a primary COVID-19 diagnosis as determined by HRSA, including the following:

  • Specimen collection, diagnostic and antibody testing
  • Testing-related visits including in the following settings: office, urgent care or emergency room or telehealth
  • Treatment, including office visit (including telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), acute inpatient rehab, home health, DME (e.g., oxygen, ventilator), emergency ambulance transportation, non-emergent patient transfers via ambulance, and FDA-approved drugs as they become available for COVID-19 treatment and administered as part of an inpatient stay
  • FDA-approved vaccine, when available

Claims will be subject to Medicare timely filing requirements, which is generally one year from the date of service.  We recommend submitting claims as soon as possible.

Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded:

  • Any treatment without a COVID-19 primary diagnosis, except for pregnancy when the COVID-19 code may be listed as secondary
  • Hospice services
  • Outpatient prescription drugs

All claims submitted must be complete and final.

Attestations and terms and conditions

To participate in the program, healthcare providers must agree to the terms and conditions at the time of registration.  The terms and conditions related to COVID-19 testing are available here.  The terms and conditions for treating uninsured patients diagnosed with COVID-19 are available here.  By accepting the terms and conditions, the provider acknowledges that each claim submitted is in full compliance with the program.

In addition to agreeing to the terms and conditions, the provider must attest to the following at the time of registration:

  • The provider has checked health care coverage eligibility (Medicare, Medicaid, individual, employer-sponsored, etc.) and confirmed that the patient is uninsured. The provider has verified that no payer will reimburse for COVID-19 testing and/or care for the patient.
  • The provider will accept defined program reimbursement as payment in full.
  • The provider will agree not to balance bill the patient.

If you have questions about the COVID-19 Uninsured Program Portal, please contact your McAfee & Taft Healthcare attorney.

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