In early April, HHS announced that a portion of the $100 billion CARES Act Provider Relief Fund would also be used to reimburse healthcare providers for COVID-related treatment of uninsured patients going back to February 4, 2020. As well, $1 billion from the Families First Coronavirus Response Act (FFCRA) also is being used to reimburse providers for conducting COVID-19 testing for the uninsured.
To access these funds, providers must enroll using their Optum Pay login on the COVID-19 Uninsured Program Portal, which is being administered by the Human Resources & Services Administration (HRSA) of HHS and UnitedHealth Group, the administrative contractor. Once enrolled, providers also will use the Uninsured Program Portal to upload patient information in order to receive temporary patient IDs. Those patient IDs are then used to submit claims for payment at traditional Medicare rates. Claims must be submitted electronically using an 837 EDI transaction set within 365 calendar days from date of service or admittance.
Both testing for COVID-19 and treatment services with a primary COVID-19 diagnosis will be reimbursed under this program, including the following:
- Specimen collection, diagnostic and antibody testing.
- Testing-related visits including in 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 (LTAC), acute inpatient rehab, home health, DME (e.g., oxygen, ventilator), emergency ground ambulance transportation, non-emergent patient transfers via ground 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.
- For inpatient claims, date of admittance must be on or after February 4, 2020.
Claims Guidance for COVID-19 Tests
Claims for diagnostic testing will be eligible for reimbursement if one of the following COVID-19 specific procedure codes is used:
Testing-related visits also will be eligible for reimbursement if the place of service is an office visit, telehealth visit, urgent care or emergency room.
For both diagnostic testing and testing related visits, one of the following diagnoses codes must be included in any position on the claim in order for the claim to be reimbursed:
- Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)
- Z11.59 – Encounter for screening for other viral diseases (asymptomatic)
- Z20.828 – Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)
Claims Guidance for COVID-19 Treatment
When billing for treatment of COVID-19 for dates of service or discharges on or after April 1, 2020, providers should use U07.1 as the primary diagnosis, except in cases of pregnancy. When billing for COVID-19 treatment for a patient who’s pregnant, use O98.5- as the primary diagnosis and U07.1 as the secondary diagnosis.
For COVID-19 treatment for dates of services or discharges prior to April 1, 2020, there is no equivalent diagnosis to indicate COVID-19 is the primary reason for treatment. In these cases, HRSA will accept B97.29 as the primary diagnosis, except in cases of pregnancy, where providers would use O98.5- as the primary diagnosis and B97.29 as the secondary diagnosis. HRSA acknowledges that using B97.29 as the primary diagnosis as described above is different from the ICD-10-CM Official Coding Guidelines – Supplement for Coding encounters related to COVID-19 Coronavirus Outbreak. HRSA advises using these codes only for submitting claims eligible for reimbursement under this program.
Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded:
- Any treatment without a COVID-19 primary diagnosis, except for pregnancy when the COVID-19 code may be listed as secondary.
- Hospice services.
- Outpatient prescription drugs.
If a patient is tested for COVID-19 in the course of being treated for another condition, the treatment for the other condition will not be reimbursed even if the patient tests positive for COVID-19. Also, in certain circumstances, the testing may not be reimbursed. Consult the HRSA COVID-19 Uninsured Program Questions and Answers from the April 29th and 30th Provider Webcasts for more information.
HRSA expects to begin distributing payments through the COVID-19 Uninsured Program by mid-May. Payments are subject to available funding. Providers will have to download 835 files and Electronic Provider Remittance Advices for the HRSA COVID-19 Uninsured Program from the View Payments tab of the program portal using their Optum Pay log-in. Those 835 files can then be uploaded into the provider’s practice management system for claim reconciliation.
For more information about COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured, check out these resources:
- The COVID-19 Uninsured Program Portal
- HRSA COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured Webpage
- HRSA COVID-19 Uninsured Program Questions and Answers from the April 29th and 30th Provider Webcasts
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