FAQs Reimbursement for COVID-19 Uninsured Treatment
How much money is available?
- Approximately $2 billion
- $1 billion through the Families First Coronavrius Response Act
- $1 billion through the Paycheck Protection Program and Healthcare Enhancement Act
- Additional funds from the $100 bill Provider Relief Fund will be allocated
Who is administering the program?
- UnitedHealth Group through a contract with the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA)
What services are eligible for reimbursement?
Healthcare providers who provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursements through the program and will be reimbursed at Medicare rates, subject to available funding.
- Specimen collection, diagnostic and antibody testing
- Testing-related visits include the following settings: office, urgent care or emergency room, or via telehealth
- Treatment, including office visit (including via telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care, 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
How do eligible providers receive funding?
To receive funding, providers must attest to the following:
- Agree not to balance bill the patient
- Agree to program terms and conditions any maybe be subject to post-reimbursement audit review
- Confirmed that the patient is uninsured, verified the patient does not have coverage such as individual, employer-sponsored, Medicare or Medicaid coverage, or no other pay will reimburse you for COVID-19 testing or treatment.
- Accept defined program reimbursement as payment in full
What is the timeline for requesting and receiving reimbursement?
All claims submissions and claims reimbursements must be submitted and remitted electronically.
- Enrollment started on April 27 for eligible providers.
- Providers can submit claims starting May 6
- Reimbursements can be expected mid-May
How are the reimbursement rates determined?
- Reimbursement will be based on current year Medicare fee schedule rates except where otherwise noted
- For any new codes where CMS published rate does note exist, claims will be held until CMS publishes corresponding reimbursement information
- Claims submitted electronically for facility services will price according to traditional Medicare reimbursement
- The following rates will apply for reimbursement of ambulance claims with a primary diagnosis of COVID-19
- Ground ambulance: $350 per claim
- Water ambulance: $350 per claim
- Air ambulance: $2,300 per claim
- Home health services will be priced based on a per-visit
- All Medicare-eligible service categories: PT/OT/ST – $90
- Nursing services
- Skilled nursing – $90
- Licensed practical nurse – $60
- Medical social services – $90
- Home health aide – $30
- Home infusion therapy
- PICC/midline supplies – $70
- PICC/midline placement – $110
Sources: Health Resources & Services Administration
Who is AdvantEdge Healthcare Solutions?
AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.
