Updated: Aug 3, 2021
“Covid, Covid, Covid” mocked the president. He may have been mocking it for political reasons, but I am not here to talk about the politics of Covid but the business behind it. Yes, Covid is a business. Especially when it comes to insurance reimbursement for covid testing.
Federal government declared a Public Health Emergency (PHE) for the Corona virus in January, 2020. Under the PHE, funds were made available to payers so that they could pay for Covid testing. Subsequent to the PHE, the Corona virus Aid, Relief, and Economic Security Act (CARES act) was passed on March 27 and on April 1 came the Families First Corona virus Response Act (FFCRA Act). The now famous Paycheck Protection Plan (PPP) was also under the purview of the same PHE.
The essence of this alphabet soup was 3 fold:
Payers must reimburse the service provider a publicly published rate for Covid testing even if the provider is not in network
Payers can not assign any amount to patient responsibility such as Copay, Coinsurance or deductible
Health Resources and Service Administration (HRSA) under HHS will reimburse providers generally at Medicare rates for testing uninsured individuals for COVID-19 and treating uninsured individuals with a COVID-19 diagnosis
All this was great news, not just for labs doing the testing but also for providers front ending the patient encounters and doing sample collection. But, not so fast. Billing companies like us feel that the primary job of payers is to find ways to not pay claims. That is what happened (still happening) with Covid claims also. People who are adjudicating claims are far removed from federal laws. Claims are not only being denied for medical necessity, they are getting paid to patient for out of network providers and patient responsibilities are being assigned for deductible and coinsurances. God help you if you try calling the payers to question the denials. People are just not aware of the law and the management is slow in training them.
We are having to appeal 80-90% of the claims providing details of the federal law thereby not only delaying payments, but also negating the benefits of electronic filing – because each appeal has to be sent by snail mail. After 7 months, things are improving especially now that there are well advertised DX and CPT codes dedicated for Covid. How to successfully bill for Covid is a discussion for another day, suffice it to say – if you are billing for Covid testing, be prepared for delayed payments and lot of time spent on phone follow ups.
If your practice is looking for more information regarding Covid-19 billing, Horizon Revenue Solutions can help. A certified medical revenue manager would be happy to take your call, or send us a message. Stay safe out there!