According to new updated CMS guidelines, the Biden administration will provide COVID-19 reimbursement to clinicians vaccinating uninsured patients. New guidance signed on January 2021, removed barriers to COVID-19 diagnostic testing and vaccinations. 

This guideline will strengthen the requirements that plans and issuers cover diagnostic testing without cost-sharing. Moreover, this guidance also strengthens current policy regarding coverage for the administration of the COVID-19 vaccine and highlights avenues for providers to seek federal reimbursement for costs incurred when administering COVID-19 diagnostic testing or a COVID-19 vaccine to uninsured people.

CMS Guidelines for COVID-19 Diagnostic Testing and Vaccinations

This guidance follows an executive order which includes five sections. We are looking the broad overview of this order below:

Section 1 - Policy

This section describes improving the capacity of the Nation's healthcare systems to address coronavirus disease 2019.

Section 2 - Accelerating the Development of Novel Therapies;

This section describes enhancing the Nation's ability to quickly develop the most promising COVID-19 interventions.

Section 3 - Improving the Capacity of the Nation's Healthcare Systems to Address COVID-19;

To boost the capacity of the healthcare systems of the nation to support healthcare workers and patients.

Section 4 - Improving Access to Quality and Affordable Healthcare;

To ease the equitable and effective distribution of therapeutics and boost clinical care capacity where needed to support patient care.

Section 5 - General Provisions.

More details of new guidance signed for COVID-19 on January 2021 by Biden Administration

The newly updated guidelines have explicitly said that private group health plans and issuers generally cannot use medical screening criteria to deny coverage for COVID-19 diagnostic tests for individuals with health coverage who are asymptomatic, also who have no known or suspected exposure to COVID-19. However, these testing must be covered without cost-sharing, prior authorization, or other medical management requirements imposed by the plan or issuer.

Additionally, Point-of-care COVID-19 diagnostic tests and COVID-19 diagnostic tests administered at the state or locally administered testing sites should be covered but plans and issuers. 

Group health plans and issuers offering group or individual healthcare coverage must cover point-of-care COVID-19 tests and tests administered at the state or locally administered testing sites as per the guidance.

Providers are have already reimbursed more than $3 billion under The HRSA COVID-19 Uninsured Program for the testing and treatment of uninsured individuals and expect to see vaccine administration claims as states scale up their vaccination efforts. 

Moreover, The FFCRA Relief Fund and PPPHCEA collectively appropriated $2 billion to reimburse providers for COVID-19 testing for individuals, while Provider Relief Fund of $178 billion has been designated for an unnamed portion of the for pandemic-related treatment of the uninsured under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).

Citation to statutory provision/ regulation:

Section 6001 of the FFCRA, as amended by section 3201 of the CARES Act

Sections 3202 and 3203 of the CARES Act

Sections 2713, 2715(d)(4), 2719, 2722, 2763, and 2791(c) of the Public Health Service Act

45 CFR 146.145(b)(3)(vi), 147.200(b), and 147.130

This program helps build awareness and seeks comment on strategies to connect those without insurance to care from providers participating in this fund. However, (KFF) analysis found that the program designed to reimburse providers for uninsured COVID-19 care as paid out limited funds suggesting the need for primary diagnosis of COVID-19.

The Departments addressed coverage requirements for COVID-19 vaccines and diagnostic testing in an interim final rule through previous guidance and rulemaking; these new guidelines enable to improve access to quality and affordable healthcare.

We are keeping track on various developments regarding covid-19 reimbursement and our professionals can help to reimburse medical billing and coding reimbursement.

Published By - Medical Billers and Coders
Published Date - Mar-15-2021 Back

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