How long will providers be able to tap into CARES uninsured reimbursement benefit for COVID care?

There is no doubt
the healthcare industry has taken a financial beating as a result of COVID-19.
But there is a glimmer of hope for providers. Several new announcements were
recently made attached to the Coronavirus Aid, Relief, and Economic
Security (CARES) Act
, specifically around reimbursements attached to COVID care for
the uninsured.

The
financial stimulus, intended to stabilize hospital finances as providers face
short-term revenue reductions due to the cessation of non-urgent procedures and
the increased costs for personal protective equipment, has earmarked a portion
of the $100B established for CARES to reimburse healthcare providers at
Medicare rates for the treatment of uninsured COVID patients.
The
guidance does not indicate specifically how much money will be set aside to
reimburse these claims.

The
big question? How long will the funds last and how quickly will providers act?

With
both unemployment, translating into more uninsured individuals, and COVID cases
on the rise, the dollars could be exhausted quickly. A recent study by Kaiser estimates
the total payments to hospitals for treating uninsured patients under the Trump
administration policy would range from $13.9B to $41.8B. While Medicare
payments are abouthalf of what private insurers
pay
on
average for the same diagnoses, estimates surrounding COVID care can be in
excess of $50k for those severe cases where struggling patients spend weeks in
the intensive care unit on a ventilator.

Bottom line, it’s likely the funds will be distributed
quickly, especially when factoring in unemployment skyrocketing. As of April
30, more than 30M Americans have filed jobless
claims
amid the coronavirus outbreak.

The all-new portal opened on April 27 for sign-ups, and
providers can begin submitting claims electronically on May 6. Healthcare
providers who have conducted COVID-19 testing of uninsured individuals or
provided treatment to uninsured individuals with a COVID-19 diagnosis on or
after February 4, 2020 can request claims reimbursement through the program
electronically and will be reimbursed at Medicare rates, subject to available
funding.

A complete list of FAQs regarding the CARES Act
and reimbursements are accessible on the Health Resources & Services
Administration website.

But what
other tips and considerations should providers contemplate as they attempt to
get their fair share? Here are three actions to optimize a provider’s chances
of claiming reimbursements for the uninsured.

Automate
the insurance check.

Providers
must attest that they have checked for healthcare coverage eligibility and
confirm the patient is uninsured. If they fail to check, they may be denied.
Providers must verify that the patient does not have coverage such as
individual, employer-sponsored, Medicare or Medicaid coverage, or any other
payer options that will reimburse for the COVID-19 testing and/or care of that
patient. There are ways to automate this step, completing a second eligibility check to attest that the patients
have no coverage before providers submit claims to the government.

Scan for the social
security number (SSN), if possible.

While there may
be instances where COVID patients entered a facility and were quickly admitted
with no formal registration process, the CARES Act states an SSN and state of
residence, or state identification/driver’s license is needed to verify
patient eligibility. If these pieces of information are not captured, providers
need to attest that they have attempted to capture this information before
submitting a claim. The patient may be long gone, but there are still ways to attempt to retrieve a patient’s SSN after they have exited
the healthcare facility
. Providers should know that claims
submitted without an SSN and state of residence, or state
identification/driver’s license may take longer to verify for patient
eligibility.Again, with the possibility that these funds could quickly be
exhausted, it is in the provider’s best interest to submit claims that are as
clean and validated as possible.

Act fast.

Recall the Small Business Administration’s Paycheck
Protection Program (PPP) — a coronavirus relief fund for small businesses that
was also established under CARES? The $350B allocated by
the bill was quickly depleted in days
. While these funds were going to
individuals in entirely different industries, there is no concrete projections
on how long healthcare providers can expect the $1B fund to cover
reimbursements for the uninsured. So, providers need to act now, and fast, by tapping into
automation
and auditing solutions that will optimize their chances of securing
their fair share.