Billing and coding for COVID-19 testing and services



4561840-66357500Billing and coding for COVID-19 testing and services4/29/20MedicareAll testing and related services are covered. Health Centers should use modifier “CS” on claims related to these services to receive 100% reimbursement with no patient cost sharing. For telehealth visits, Medicare is temporarily covering distant site video+audio visits provided to patients. This will be in effect through the national public health emergency. Several health centers complete a remote visit to determine if a patient should be brought in for testing. Details on how to bill for these telehealth visits is outlined in an MLN Matters document SE200016.Telehealth is subject to coinsurance (unless related to COVID-19), but Medicare is allowing providers to waive this for patients.MedicaidForwardHealth, including managed care organizations, will accept the new procedure codes developed by CMS to test patients for SARS-CoV-2 specific to the 2019 Novel Coronavirus. Providers and laboratories will be able to bill for services that occurred after February 4, 2020. DMS reimbursement will be 100% of the Medicare rate.Health Centers should follow the FowardHealth COVID-19 website for up-to-date information about accepted procedure and HCPCS codes for COVID-19 testing.Medicaid waived all copays beginning January 1, 2020 through June 30, 2020.Medicaid has broadly expanded their coverage of virtual visits, including audio only, during the state’s public health emergency (due to expire on May 12). Health Centers are eligible for receiving their PPS rate for these visits. HYPERLINK "" WPHCA Virtual Visit Coding GridWPHCA Virtual Visit FAQUninsuredFQHCs may waive SFS charges for COVID-19 testing and evaluation, but should take steps to document compliance. Health centers are permitted – but not currently required – to waive SFS for COVID-related evaluation and testing. ?However, to ensure compliance, it is advisable that the center:have a board resolution authorizing the management to establish an emergency process for the duration of the emergency under which the health center will waive the fees for uninsured patients, and establish an emergency waiver policy / procedure (or amend its current waiver policy / procedure) and include an attestation (as described in the attached) in order to comply with the waiver provisions in Chapter 16 of the Compliance Manual, as well as to ensure uniform application. The CARES Act included some additional provisions for covering the uninsured:Beginning April 27, providers can register for a program through HRSA to be reimbursed for COVID related services provided to uninsured patients.Every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the HRSA program and will be reimbursed at Medicare rates, subject to available funding.Steps will involve: enrolling as a provider participant, checking patient eligibility and benefits, submitting patient information, submitting claims, and receiving payment via direct deposit. Claims submission can begin on May 6 and payment should begin on May 18.As a condition, providers are obligated to abstain from "balance billing" any patient for COVID-19-related treatment. For more information, visit the following:coviduninsuredclaim. by several national health insurance companies has been collated in the following resource: First requires insurance carriers to cover 100% of COVID testing, but some services may not be covered if patients go out of network.CARES Act requires providers to post the cash price of evaluation and testing services on their public websiteApril 11 CMS FAQ the plan or issuer does not have a negotiated rate with such provider, the plan or issuer shall reimburse the provider in an amount that equals the cash price for such service as listed by the provider on a public internet website, or the plan or issuer may negotiate a rate with the provider for less than such cash price.Section 3202(b) of the CARES Act also requires providers of diagnostic tests for COVID-19 to make public the cash price of a COVID-19 diagnostic test on the provider’s public internet website. Section 3202(b) of the CARES Act also grants the Secretary of HHS authority to impose civil monetary penalties on any provider that does not comply with this requirement and has not completed a corrective action plan, in an amount not to exceed $300 per day that the violation is ongoing. ................
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