Medical Billing ServicesRevenue Cycle Management (RCM)

Uninsured COVID-19 Patients with Limited Reimbursement

According to a recent report from the Kaiser Family Foundation (KFF), a program intended to balance the costs of uninsured COVID-19 patients during the coronavirus emergency has paid out limited reimbursement to providers.

The Trump Administration announced the COVID-19 treatment reimbursement program for uninsured patients in April 2020. The program has been in place from the last five months, this program using funds from the Coronavirus Aid, Relief, and Economic Security (CARES) Act’s $175 billion Provider Relief Fund to reimburse providers for treating uninsured patients with COVID-19.

Factors limiting reimbursement to Providers

The major factor behind the limiting reimbursement to providers for the treatment of uninsured COVID-19 patients as follows:

  • According to the KFF report, this is the newer policy that makes reimbursement contingent upon a primary diagnosis of COVID-19

KFF report also wrote that “In some cases, patients with COVID-19 who are being treated for symptoms brought on by the virus may not have a primary diagnosis of COVID-19.”

Leading hospital groups from the U.S. including the American Hospital Association (AHA) and the Federation of American Hospital (FAH) have expressed their worries about this new policy for patients with sepsis caused by the Coronavirus. Moreover, medical coding protocols state that these patients are coded with sepsis as their primary diagnosis and not COVID-19, the KFF report stated.

Other factors listed in the KFF report as limiting the reach of the COVID-19 treatment reimbursement program is that providers are not required to participate in this program, patients do not have information about the providers participation. If the provider is not chosen to participate into this program then they may bill at their list price for care, and that the program is contingent on what is left in the Provider Relief Fund.

Another significant limitation of the policy is that this program does not guarantee reimbursement for providers. Instead, reimbursement is contingent on available funding.

The Provider Relief Fund has already distributed nearly $144 billion to providers since its establishment in March 2020, according to the latest announcement from HHS. That leaves about $31 billion left in the Provider Relief Fund. HHS has not specified how much money – if any – is being set aside to cover the costs of treating uninsured COVID-19 patients and how it will weigh the needs of that program with the ongoing needs of providers.

Refer below picture (Source):

Announced Provider Relief Allocations as of Oct, 7, 2020

Researchers estimated that hospital costs alone for the treatment of uninsured COVID-19 patients could be as much as $42 billion depending on the number of people who have got infected with the virus and are have got admitted to the hospital for care.

“Policy options that enable people to afford and enroll in comprehensive health insurance would help them access care for all their health care needs, including possible COVID-19 testing and treatment, although these policies would likely increase government spending,” KFF said.

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Medical Billers and Coders

Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.

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