Since Jan 1 2021, Medicare has started reimbursing independent labs $75 per COVID-19 PCR testing claim for HCPCS code U0003 and U0004. There is also a potential add-on reimbursement amounting to $25 for HCPCS code U0005, applicable only if the testing results are returned to the patients within 48 hours. The reimbursement is based on the fee schedule rates of Medicare and must be submitted and remitted electronically.
As part of the enacted legislation, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Coronavirus Response and Relief Supplemental Appropriations Act (CRRSA), the Paycheck Protection Program (PPP) and Health Care Enhancement Act, the Families First Coronavirus Response Act will provide reimbursement to healthcare providers for testing, treating and vaccine administration to the uninsured.
What are the steps for eligible providers?
The key steps will involve enrolling as a provider participant, checking patient eligibility, submitting patient information, submitting claims and receiving payment via direct deposit. Providers are also allowed to submit claims for uninsured individuals in the US without insurance coverage through the HRSA COVID-19 Uninsured Program.
How is it covered?
From administering vaccines like Pfizer, Moderna, and Janssen, to testing for coronavirus infection via diagnostic tests such as RTPCR, Antigen, and Rapid Antigen, to treatment with antiviral medication – almost all aspects of Covid-19 infection are covered. The HRSA Program, for example, covers testing and testing related visits, treatment with a Covid-19 diagnosis and also Covid-19 vaccination administration fees will be covered. The steps you will be needed to take as a provider are:
- Validating your TIN
- Adding your provider roster
- Registering for direct deposit
- Adding and attesting your patient roster
- Submitting the claim(s)
- Collection of reimbursement(s)
What are the timely filing limit guidelines?
To manage your HRSA billing, you will be needed to submit claims within 365 days from date of service or admission for reimbursement, which is subject to available funding.
How Sunknowledge add value?
Our Covid/HRSA billing services starts right after the physician signs the medical notes. Within 48 hours, we start creating the chart and follow the coding mandates. All patient demographic entries, checking of eligibilities will be our responsibility. Claims are submitted starting from the oldest to the newest date of service.
Some of the significant aspects of the process are:
- A temporary member ID will be generated for each individual after submitting patient information that will be displayed in the program portal in less than 24 hours.
- All claims have to be submitted electronically outside of the program portal using 837 EDI transaction set and the following information:
- Payer ID: 95964
- Payer name: COVID19 HRSA Uninsured Testing and Treatment Fund
- Temporary member ID for each patient (found in the portal after the patient roster is submitted)
- After the claim is processed and approved, Optum Pay™ will be remitting the payment to the provider’s account electronically. This may take 7–10 business days to get processed.
The Sunknowledge advantage
At a time of serious labor shortage, supply constraints, and rising costs, we can work on your pending backlogs and help you manage your patient volume efficiently, be it in an office, lab, hospital, or Urgent Care setting with our specialized intervention. At just $7 per hour, we are your best fit as we start right from the beginning of the billing cycle and stop only after realizing your reimbursements.
Trust Sunknowledge’s Covid lab/HRSA billing services to help you do what you know best – taking care of the diagnosis, testing, treatment and administering vaccines to your patients.
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