In response to the global COVID-19 pandemic, the herculean efforts by healthcare providers across the country have been met with fundamental shifts in reimbursement regulation. Here, we break down the most important information on the effort to bring much-needed relief to providers serving uninsured patients.
In April, the U.S. Department of Health and Human Services (HHS), through the Health Resources & Services Administration (HRSA), launched the HRSA COVID-19 Uninsured Program, which will provide claims reimbursement to healthcare providers generally at Medicare rates for testing uninsured individuals for COVID-19 and treating uninsured individuals with a COVID-19 diagnosis.
The program is funded by:
The Families First Coronavirus Response Act (FFCRA) which appropriated $1 billion in reimbursement funding to providers testing uninsured COVID-19 patients;
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, which appropriated $100 billion in relief funds to hospitals and health care providers, a portion of which is earmarked to reimburse treatment of uninsured individuals with COVID-19; and
The Paycheck Protection Program and Health Care Enhancement Act, which appropriated up to $1 billion to reimburse providers testing uninsured COVID-19 patients and an additional $75 billion to the Provider Relief Fund.
How it works: Providers who have conducted COVID-19 testing or provided treatment for uninsured individuals on or after February 4, 2020, can request claims reimbursement through the program electronically. HRSA has contracted with UnitedHealth Group to be the sole administrator of this program, and providers will use a unique identifier that enables participation.
Steps involved: Enrolling as a provider participant, checking patient eligibility, submitting patient information, submitting claims electronically and receiving payment via direct deposit.
“We have seen the heroic actions from healthcare providers serving on the frontlines of the pandemic,” said Tom Engels, HRSA Administrator, in a recent HHS release. “These reimbursements help meet the growing demand for testing and health care provider services related to the COVID-19 pandemic, and ensure that uninsured individuals get the care they need.”
Important Questions to Consider
Who is considered an “uninsured individual” for purposes of providers requesting reimbursement for testing or treatment?
For claims for COVID-19 Testing and Testing-Related Items and Services, a patient is considered uninsured if the patient does not have coverage through an individual, or employer-sponsored plan, a federal healthcare program, or the Federal Employees Health Benefits Program at the time the services were rendered. For claims for treatment for positive cases of COVID-19, a patient is considered uninsured if the patient did not have any health care coverage at the time the services were rendered.
Do healthcare providers need to determine if an otherwise uninsured individual is Medicaid eligible?
Providers must verify and attest that to the best of the provider’s knowledge, the patient does not have individual, employer-sponsored, Medicare or Medicaid coverage, and no other payer will reimburse them for COVID-19 testing and/or treatment for that patient. Providers may submit a claim for uninsured individuals before Medicaid eligibility determination is complete. However, if the individual is retroactively enrolled in Medicaid as of the date of service, the provider must return the payment to HRSA.
HRSA has addressed a thorough list of FAQs, covering questions like:
- What type of providers are eligible for the program?
- What services are eligible/ineligible for reimbursement?
- Are claims subject to timely filing limits?
The FAQs address questions around testing and treatment, payment (including a timeline for requesting and receiving reimbursement) and compliance and reporting questions.
Help where and when you need it most
eSolutions’ helps providers meet the eligibility attestation requirements with our best-in-class eligibility tools, plus our Insurance Discovery product, which can help find coverage for previously unidentified Medicare, Medicaid and commercial claims.
Using Insurance Discovery, eSolutions can run a special report on a provider’s COVID-19 patients and pinpoint those patients with no identified insurance. Our exclusive data finds available patterns and rates of dispersion, giving providers a more accurate picture of the spread of COVID-19 in their geographic areas.
This map offers an example of what providers can discover with eSolutions. (click map to view full size image)
For illustrative purposes only.
Even before the public health emergency and COVID-19 crisis, the patient coverage landscape was seeing substantial changes due to high-deductible insurance plans, Medicaid expansion and patients rapidly aging into Medicare. Now more than ever, it’s critical for providers to take charge of their reimbursement related to uncompensated care.
eSolutions’ Insurance Discovery employs proprietary algorithms to automate the categorization of data received from providers, Medicare, Medicaid, Managed Care and commercial payers. We’ve built our technology to ensure scalability and reliability of service, resulting in a fast, automated, and highly accurate solution. Insurance Discovery has helped providers recover, on average, 5-12% of accounts.
Insurance Discovery includes a user-friendly dashboard and analytics tool to monitor performance, conveniently customize reports, and facilitate accurate and timely delivery of KPIs for every level of our providers’ organization.
If you have questions regarding the HRSA COVID-19 Uninsured Program and what it means for your organization, or would like to learn more about the ways we can help you manage uninsured patients and uncompensated care costs, contact us at (866) 633-4726 or via email at email@example.com.