Provider uncertainty appears to be hampering participation in this program.

There are still some providers that are unsure how to participate in and bill for providing COVID-19 services to the uninsured through the Health Resources and Services Administration (HRSA). 

Since Feb. 4, 2020, providers that have conducted COVID-19 testing or provided treatment for the uninsured can request claims reimbursement through the program electronically, and will be reimbursed generally at Medicare rates, subject to available funding. Providers can also request reimbursement for COVID-19 vaccine administration. To get paid, you must:

  • Enroll as a provider participant;
  • Check patient eligibility;
  • Submit patient information; and
  • Be able to submit claims and receive payment via direct deposit.

To participate, providers must also attest to the following at registration:

  • They have checked for healthcare coverage eligibility and confirmed that the patient is uninsured;
  • They will accept defined program reimbursement as payment in full;
  • They agree not to balance bill the patient; and
  • They agree to program terms and conditions, and may be subject to post-reimbursement audit review.

Reimbursement under this program will be made for qualifying testing for COVID-19, treatment services with a primary COVID-19 diagnosis, and qualifying COVID-19 vaccine administration fees, as determined by HRSA (subject to adjustment, as may be necessary). This includes 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: office visit (including telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), rehabilitation care, home health, durable medical equipment (e.g., oxygen, ventilator), emergency ambulance transportation, non-emergent patient transfers via ambulance, and FDA-licensed, authorized, or approved treatments as they become available for COVID-19 treatment; and
  • Administration fees related to FDA-licensed or authorized vaccines.

The following caveats also apply:

  • Services not covered by Medicare are not covered;
  • Claims will be subject to Medicare timely filing requirements;
  • Any treatment without a COVID-19 primary diagnosis, except for pregnancy, when the COVID-19 code may be listed as secondary;
  • Hospice services are not covered;
  • Outpatient prescription drugs are not covered; and
  • All claims submitted must be complete and final.

 

Programming Note: Listen to Tim Powell every Tuesday on Talk Ten Tuesdays, 10 Eastern.

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