Update: On Oct. 1, 2020, the U.S. Department of Health and Human Services, through the Health Resources and Services Administrative (HRSA), announced $20 billion in new Phase 3 General Distribution Funding for providers from the Public Health and Social Services Emergency Fund (Provider Relief Fund). For more information, please see our Oct. 2, 2020, alert.
Update (May 22, 2020): Eligible providers have until June 3, 2020, to
take action to be eligible to receive an additional payment from the Provider
Relief Fund General Distribution, as discussed in a May 22, 2020 alert, which
also discusses updated guidance.
On April 27, 2020, the U.S. Department of Health and Human Services (HHS), through its Health Resources and Services Administration (HRSA), provided additional guidance for healthcare providers seeking to participate in the HRSA COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured Program (HRSA COVID-19 Uninsured Program). It also opened the COVID-19 Uninsured Program Portal.
The HRSA COVID-19 Uninsured Program provides funding for qualifying healthcare providers conducting COVID-19 testing for uninsured patients or providing treatment to uninsured patients with a positive COVID-19 diagnosis on or after Feb. 4, 2020. Qualifying healthcare providers can use the portal now to enroll in the HRSA COVID-19 Uninsured Program. Beginning May 6, qualifying healthcare providers may submit patient information through the portal and submit claims for reimbursement using an 837 EDI transaction set.
HRSA has provided many forms of guidance for healthcare providers seeking to enroll in the HRSA COVID-19 Uninsured Program. HRSA’s COVID-19 Uninsured Program webpage was updated to include answers to frequently asked questions, and the COVID-19 Uninsured Program Portal contains a user guide and step-by-step instructions for enrollment and claims submission. HRSA will also provide live webinars on April 29 and 30, from 2 to 3 p.m. (ET), with advice for utilizing the program.
Funding for the HRSA COVID-19 Uninsured Program comes from the Families First Coronavirus Response Act (FFCRA), which allocates $1 billion to COVID-19 testing for uninsured patients, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which allocates an unspecified portion of the $100 billion CARES Act provider relief fund to treatment of uninsured patients with a positive COVID-19 diagnosis.
Below are key details about the HRSA COVID-19 Uninsured Program, related to eligibility requirements, covered services, registration, claims submission and reimbursement.
Providers that have treated uninsured COVID-19 patients with dates of service or admittance on or after Feb. 4, 2020, are eligible to participate in the HRSA COVID-19 Uninsured Program, and may request claims reimbursement through the program. Claims must be submitted electronically and will be reimbursed at Medicare rates, subject to available funding and timely filing requirements. Providers began registering for the program on April 27, 2020, and may begin submitting claims on May 6, 2020, with payments expected to begin no earlier than May 18, 2020.
To enroll in the HRSA COVID-19 Uninsured Program, an eligible healthcare provider must (1) enroll as a provider participant through the COVID-19 Uninsured Program Portal, (2) confirm patient eligibility, (3) submit patient information and attest to patient eligibility through the COVID-19 Uninsured Program Portal, (4) submit claims for covered services, and (5) receive payment via direct deposit. When confirming patient eligibility, healthcare providers should check each patient’s healthcare coverage eligibility and confirm each submitted patient is uninsured (i.e., verify that the patient does not have individual, employer-sponsored, Medicare or Medicaid coverage, and no other payer will reimburse the provider for COVID-19 testing and/or treatment for that patient).
Eligible healthcare providers will be permitted to seek reimbursement for COVID-19 testing and testing-related visits for uninsured individuals, as well as treatment for uninsured individuals diagnosed with COVID-19. All claims will be subject to the same timely filing requirements required by Medicare.
Reimbursement will be made for qualifying testing for COVID-19 and treatment services with a primary COVID-19 diagnosis, including the following:
- Specimen collection, diagnostic and antibody testing.
- Testing-related visits to a provider’s 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, durable medical equipment (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 Feb. 4, 2020.
Services not covered by traditional Medicare will 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.
Registration and Attestation
As part of the registration process for the program, eligible healthcare providers must make certain attestations, including that the provider has verified the patient’s uninsured status, accepts the defined program reimbursement as payment in full, will not balance bill patients seeking care for presumptive or actual cases of COVID-19, agrees to the program terms and conditions, and will comply with any program audit. These attestations are consistent with the “strings attached” to the general provider relief funding, prohibiting providers from balance billing patients, as discussed in a previous McGuireWoods legal alert. HHS created two separate terms and conditions for providers participating in the HRSA COVID-19 Uninsured Program. The FFCRA Relief Fund Payment Terms and Conditions are applicable to providers conducting COVID-19 testing, and the Uninsured Relief Fund Payment Terms and Conditions are applicable to providers treating uninsured patients with a positive diagnosis of COVID-19.
Beginning May 6, 2020, enrolled healthcare providers may begin submitting claims electronically for professional and facility services provided to uninsured COVID-19 patients using an 837 EDI transaction set outside of the HRSA COVID-19 Uninsured Program Portal. HRSA released detailed coverage and coding guidelines. As part of the claims submission process, enrolled healthcare providers will need to provide the following information.
- Payer ID: 95964,
- Payer Name: COVID19 HRSA Uninsured Testing and Treatment Fund
- Temporary member ID for each patient, available in the portal as discussed above
Because all claims submitted will be treated as complete and final, HRSA has established a process for automatically catching claims with potential billing errors and will provide healthcare providers with the opportunity to correct such claims at the time of submission. HRSA has expressly stated that it will not accept any interim bills, corrected claims, late charges, voided claim transactions or appeals. While some of the logistics for claims submission remain unclear, HRSA may provide additional guidance during the live webinar or through the portal before May 6.
Once a claim is processed and approved for payment, Optum Pay will send an electronic payment to an enrolled healthcare provider’s account in approximately 7 to 10 business days. The earliest a healthcare provider will receive payment is May 18, 2020.
McGuireWoods is continuously monitoring information released by HHS and the Trump administration regarding the HRSA COVID-19 Uninsured Program. Please contact the authors or any of the McGuireWoods COVID-19 Response Team members for additional information on the program and its availability to healthcare providers and for assistance with the documentation and reporting process.
In a series of video alerts, McGuireWoods’ healthcare lawyers address
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