- Payments to hospitals for the testing and care of uninsured COVID-19 patients will begin in mid-May.
- Providers can take initial steps to prepare for the May 6 start of claims submissions.
- Providers must agree to certain terms and conditions to be paid.
The timing of the first federal payments for care provided to uninsured COVID-19 patients was among the growing number of details to emerge this week regarding the payments.
The multibillion federal payments for uninsured COVID-19 patients, as administered by the Health Resources and Services Administration (HRSA), will begin to be paid electronically in mid-May, according to HRSA officials.
The payments for testing and treatment of COVID-19 patients — starting Feb. 4 — will use current-year CMS pricing with geographic adjustments, as applicable. Providers can access the portal to register for the payments at COVIDUninsuredClaim.HRSA.gov.
The next steps in the process are:
- Checking patient eligibility and benefits
- Submitting patient information
- Submitting claims
- Receiving payment via direct deposit (no paper checks will be sent)
Registration for the payments opened to providers April 27, and claims submission can begin May 6.
How much funding is available?
Federal officials repeatedly have declined to say what amount has been allocated to pay for the care of uninsured COVID-19 patients.
The Families First Coronavirus Response Act and the Paycheck Protection Program and Health Care Enhancement Act each provided about $1 billion for COVID-19 testing of uninsured patients. And the Trump administration allowed funding for COVID-19 treatments to come out of the $100 billion provider fund included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Administration officials said the funding for the treatment of uninsured COVID-19 patients will come from the $29.6 billion in Provider Relief Fund money that has not been specifically allocated to various providers.
How to get paid
Funding and payment rules are set by HRSA, while its contractor, UnitedHealth Group (UHG), is administering the program.
In a webinar this week, HRSA and UHG officials emphasized key points for providers that included:
- Checking the patients for other coverage and confirming the patients are uninsured
- Accepting the payment provided and not engaging in balance billing
- Submitting to a post-payment audit
- Ensuring COVID-19 is the primary diagnosis, except when pregnancy is
Initial preparation for claims submission
Tim Kaja, chief operating officer for provider networks at UnitedHealthcare, said providers planning to submit claims should begin preparing before the May 6 start of claims submission. Steps include:
- Rgistering an account on Optum Pay (can take 7-10 days)
- Validating your organization’s taxpayer identification number (1-2 days)
- Establishing direct deposit with Optum
- Upoading your provider roster (1 day)
Other key details
Although Social Security numbers and states of residence for patients are not required, Mary Murley, a chief actuary for UnitedHealthcare, said the program will require providers to certify they tried to get that information and couldn’t.
Providers obtaining payments through the program will not be required to sign a contract with UHG or anyone else. Instead, they must attest to the accuracy of the information submitted. Billing companies and revenue cycle vendors are authorized to attest for the provider that the information is accurate.
No claims may be repealed or reprocessed after submission. Optum will not add any charges to process the claims.
Providers will need to have a clearinghouse relationship or similar to submit claims electronically, Kaja said.
UHG officials emphasized that providers would not qualify for payments if the initial reason for the clinical consult was listed as the primary diagnosis and then COVID-19.
Federally qualified health centers, free clinics, not-for-profit hospitals and other provider types all may participate in the program, the officials said, as long as they meet the previously specified criteria for the program.