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.

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