Few Claims Made by Physicians for Uninsured COVID Care: HHS

Alicia Ault

July 10, 2020

A senior official at the US Department of Health & Human Services (HHS) said the agency has received far fewer claims than expected from clinicians and hospitals for COVID-19–related testing and treatment for uninsured patients.

The official was speaking to reporters on background during a briefing on a new $4 billion distribution of federal COVID-19 relief money to safety net hospitals and hospitals that primarily serve rural populations.

The Health Resources and Services Administration (HRSA) began accepting applications on April 27 for reimbursement from hospitals, physicians, and others seeking payment for a diagnostic or antibody test or treatment for uninsured patients presumed to have COVID-19 or who tested positive for the disease.

The federal official, who cannot be quoted, said that so far, HHS has paid out some $340 million in claims. Payouts were to begin in mid-May, but the official did not give a timeframe for the $340 million figure. It is "less than we had expected to distribute," said the official. HHS has not put any limit or cap on how much it will reimburse for the claims, which are paid at the Medicare rate. The agency probably has an additional $40 billion to 50 billion in spending flexibility for the uninsured, said the official.

He speculated that many hospitals or doctors might not be aware of the ability to be reimbursed for uninsured patients with COVID-19. Doctors and hospitals can seek payment for services dating back to February 4. They must enroll, check patient eligibility and benefits, submit patient information, and submit a claim.

For testing, the program covers specimen collection, diagnostic and antibody testing, and testing-related visits at physician offices, urgent care facilities, or emergency departments or by telehealth.

The program also covers inpatient, outpatient/observation and skilled nursing facility care; long-term acute care; acute inpatient rehab; home health; durable medical equipment (such as oxygen or a ventilator); emergency ambulance transportation; and non-emergent transfers by ambulance.

Drug therapies are not covered unless they are approved by the US Food and Drug Administration and only when given during an inpatient stay. The agency has not formally approved any drug therapy for COVID-19.

It has given an emergency use authorization (EUA) for three therapies: remdesivir, a drug to maintain continuous sedation for ventilated patients, and one for a dialysis therapy. It is not clear from the HRSA website whether drugs with an EUA are reimbursable.

New Money for Hospitals, Dentists

Safety net hospitals have already received $10 billion in COVID-19 relief, but some 215 acute care hospitals did not qualify in that initial round. The agency is now distributing $3 billion to those facilities. With that new money, HHS will have sent relief to 959 hospitals that serve the most vulnerable.

The agency also announced that it would distribute $1 billion to hospitals that might be in urban areas but serve rural patients primarily. About 500 hospitals will be eligible for the $1 billion, with payments ranging from $100,000 to $4.5 million. That's in addition to the $10 billion already distributed in late April to 4000 rural hospitals, clinics, and health centers.

Clinicians who bill Medicare or Medicaid have been eligible for relief payments, but they also must agree to terms and conditions and then attest to having received the money. The HHS official said the agency has tried to make it easier for clinicians to comply, aiming to speed up payments and track how much money has actually been received.

Some behavioral health specialists have not been eligible for pay, but the agency is working to get money to them in the next round, said the official.

Dentists will also now for the first time be able to apply for relief funds through the HHS portal, hhs.gov/providerrelief.

Additional Hot Spot Pay Coming

HHS has distributed a total of around $113 billion COVID-19–related money to hospitals, physicians, skilled nursing facilities, and Indian Health Service facilities and clinicians, said the agency official. That leaves about $40 billion to 50 billion in the current relief fund.

In April, HHS distributed $10 billion to clinicians and hospitals in COVID-19 hot spot areas. New York received almost half that money. HHS has surveyed hospitals around the country and found that admissions between April and June "continued to be significant," said the official.

The agency will announce a new round of hot spot distributions soon, he said.

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