Frequently Asked Questions for the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured Program

General Questions

What is the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured Program?

How much money is available in the fund?

Who is administering the program?

Eligibility Questions

Who is eligible for funding?

Who is considered to be an "uninsured individual" for purposes of providers requesting reimbursement for testing or treatment?

Can health care providers submit claims for uninsured individuals who are undocumented?

Do health care providers need to determine if an otherwise uninsured individual is Medicaid eligible?

What is the difference between the funds available to reimburse providers for COVID-19 testing and treatment services furnished to uninsured individuals through the Health Resources and Services Administration (HRSA) and the funds available through the Families First Coronavirus Response Act (FFCRA) to provide Medicaid coverage of COVID-19 testing services for uninsured individuals?

Which type of health care providers are eligible for reimbursement under this program? Are non-profits or Federally Qualified Health Centers (FQHCs) eligible?

If a hospital charity program covered all of the cost of an uninsured individual’s treatment for COVID-19, can a health care provider submit a claim for reimbursement?

The Ryan White HIV/AIDS Program is a payer of last resort, would these program funds be considered a payer before this fund?

Are pharmacies/pharmacists that administer COVID-19 tests eligible providers for reimbursement under the program?

Are Indian Health Service (IHS), Tribal and Urban Indian Program (I/T/Us) beneficiaries considered “uninsured individuals” for purposes of the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured programs?

Who is ineligible for payment from the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured program?

What services are eligible for reimbursement?

Why is claim reimbursement eligibility for diagnostic testing services performed by independent labs different than claim reimbursement eligibility for such services performed by hospitals (including hospital labs) or physicians?

Can health care providers submit a claim for testing furnished to an uninsured individual that is performed by a laboratory with which it has a client bill arrangement?

What services are ineligible for reimbursement?

Are claims subject to timely filing limits?

Are diagnostic testing and testing-related visits eligible for reimbursement if the result of the COVID-19 test is negative?

If a provider tests for COVID-19 as part of pre-operative or other medical treatment unrelated to COVID-19, is the test eligible for reimbursement?

If a patient is admitted to the hospital and a COVID-19 test is performed, the results of which are negative, is the test or any part of the inpatient claim eligible for reimbursement?

If a patient presents to the emergency department with cough and fever and then tested negative for COVID-19, would the test and the emergency room visit be eligible for reimbursement?

Can funds be used for remote screening activities even if they do not administer an actual test?

If a patient is being treated for cancer and also tests positive for COVID-19, is the cancer treatment eligible for reimbursement?

The Terms and Conditions for the Uninsured Treatment pool of funding indicate that providers can request claims for reimbursement for care or treatment related to positive diagnoses of COVID-19. To qualify as a positive diagnosis of COVID-19, does the primary diagnosis on a claim for treatment need to be B97.29 or U07.1?

If a patient is treated for sepsis and also tests positive for COVID-19, is the sepsis treatment eligible for reimbursement?

Prior to the April 1, 2020, effective date for U07.1 COVID-19 diagnosis, the program guidelines indicate that treatment would be eligible for reimbursement if B97.29 is the primary diagnosis. Can B97.29 be used for a primary diagnosis?

Are ambulance providers and other emergency medical service providers eligible for reimbursement for treatment services? Will claims for presumptive diagnoses be eligible for reimbursement under this program?

Payment Questions

How do eligible providers receive funding?

What is the timeline for requesting and receiving reimbursement?

How do eligible providers submit claims?

What type of unique identifiable identification information is required when submitting patient information?

If a temporary member ID is valid for 30 days, can providers still submit a claim after the 30-day period is over?

Can providers submit a paper reimbursement request and/or request reimbursement via check?

Do providers have to pay back the funding they received?

How are the reimbursement rates determined?

Given the Uninsured program is paid generally at Medicare rates, will reimbursement include the 20% add-on to the Medicare diagnosis related group (DRG) payment for COVID-19 treatment?

If a provider already received payment from an uninsured individual, are they required to reimburse that individual after receiving payment from the program?

Compliance Questions

How should providers account for these funds for purposes of cost reports and similar reports?

 

Date Last Reviewed:  May 2020