COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured

President Trump is providing support to health care providers fighting the COVID-19 pandemic. The President signed the bipartisan:

• Families First Coronavirus Response Act or FFCRA (P.L. 116-127) and the Paycheck Protection Program and Health Care Enhancement Act or PPPHCEA (P.L. 116-139), which each appropriate $1 billion to reimburse providers for conducting COVID-19 testing for the uninsured; and the
• Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136), which provides $100 billion in relief funds, including to hospitals and other health care providers on the front lines of the COVID-19 response, and the PPPHCEA, which appropriated an additional $75 billion in relief funds. Within the Provider Relief Fund, a portion of the funding will be used to support healthcare-related expenses attributable to the treatment of uninsured individuals with COVID-19. A portion of the funding will also be used for COVID-19 vaccine administration to uninsured individuals when the Food and Drug Administration (FDA) authorizes a vaccine under an Emergency Use Authorization (EUA) or licenses a vaccine under a Biologics License Application (BLA).

About the program

As part of the FFCRA, PPPHCEA, and CARES Act, the U.S. Department of Health and Human Services (HHS), will provide claims reimbursement to health care providers generally at Medicare rates for testing uninsured individuals for COVID-19 and treating uninsured individuals with a COVID-19 diagnosis. A portion of the funding will also be used to reimburse providers for COVID-19 vaccine administration to uninsured individuals.

Physicians and other health care providers are true heroes – especially during the COVID-19 outbreak – and HHS is grateful for their continued dedication.

How it works

Health care providers who have conducted COVID-19 testing or provided treatment for uninsured individuals with a COVID-19 primary diagnosis on or after February 4, 2020 can request claims reimbursement through the program electronically and will be reimbursed generally at Medicare rates, subject to available funding. Providers can also request reimbursement for COVID-19 vaccine administration once available. Steps will involve: enrolling as a provider participant, checking patient eligibility, submitting patient information, submitting claims, and receiving payment via direct deposit.

To participate, providers must attest to the following at registration:

• You have checked for health care coverage eligibility and confirmed that the patient is uninsured. You have verified that the patient does not have coverage through an individual, or employer-sponsored plan, a federal healthcare program, or the Federal Employees Health Benefits Program at the time services were rendered, and no other payer will reimburse you for COVID-19 testing and/or care for that patient.
• You will accept defined program reimbursement as payment in full.
• You agree not to balance bill the patient.
• You agree to program terms and conditions and may be subject to post-reimbursement audit review.

Program timeline

• April 22 – Program Details launch
• April 27 – Sign up period begins for the program
• April 29 – On Demand training starts
• May 6 – Begin submitting claims electronically
• May 18 – Begin receiving reimbursement

For whom can claims be submitted

Providers may submit claims for individuals in the U.S. without health care coverage.

What's covered

Reimbursement under this program will be made for qualifying testing for COVID-19, for treatment services with a primary COVID-19 diagnosis, and for qualifying COVID-19 vaccine administration fees, as determined by HRSA (subject to adjustment as may be necessary), which include the following:

• Specimen collection, diagnostic and antibody testing.
• Testing-related visits including in the following settings: office, urgent care or emergency room or telehealth.
• Treatment: office visit (including telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), rehabilitation care, home health, durable medical equipment (e.g., oxygen, ventilator), emergency ambulance transportation, non-emergent patient transfers via ambulance, and FDA-licensed, authorized, or approved treatments as they become available for COVID-19 treatment.
• When a FDA-licensed or authorized vaccine becomes available, the administration fees for the vaccine will be covered.

Claims will be subject to Medicare timely filing requirements.

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.

All claims submitted must be complete and final.

Claims Submission

Information on claims submission can be found at: coviduninsuredclaim.linkhealth.com .

Claims Reimbursement

Claims for reimbursement will be priced as described below for eligible services (see coverage details above).

• Reimbursement will be based on current year Medicare fee schedule rates except where otherwise noted.
• Reimbursement will be based on incurred date of service.
• Publication of new codes and updates to existing codes will be made in accordance with CMS.
• For any new codes where a CMS published rate does not exist, claims will be held until CMS publishes corresponding reimbursement information.

When can I learn more?

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