Updated Guidelines For COVID-19 Testing, Vaccines, & Reimbursement

On February 26, 2021, the Biden administration released additional guidance clarifying reimbursement for COVID-19 tests to insured individuals and for providing testing and vaccinations to the uninsured.

COVID-19 Diagnostic Testing

Health plans cannot deny coverage for COVID-19 diagnostic tests to individuals who present no symptoms or have no known exposure to the virus. The clarification comes after many questions have been raised about the plan and the issuer’s responsibility to cover COVID-19 diagnostic testing for asymptomatic individuals.

In a statement, CMS said that: “Testing must be covered without cost-sharing, prior authorization, or other medical management requirements imposed by the plan or issuer.”

Lori Intravichit, CEO of Sunlit Cove Healthcare said:

It's about time that we do not penalize healthy individuals for doing the right thing by getting tested before family gatherings. It is another step forward in battling the pandemic.

COVID-19 Vaccines

The CARES Act requires that COVID-19 preventative services like immunization must be covered without cost-sharing. Based on the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention vaccine recommendation, insurance plans are required to begin coverage within 15 business days. This means the coverage has already started January 5, 2021, for the Pfizer BioNTech vaccine, January 12, 2021, for the Moderna vaccine, and the Johnson & Johnson vaccine coverage requirement will become effective March 19, 2021. Let’s not forget about the administration fees; they are covered as well!

Uninsured Patients

The new guidance also reminds healthcare providers that the portion of the Provider Relief Fund (“PRF”) established under the CARES Act is available to reimburse providers for COVID-19 testing and testing-related visits, treatment for individuals with a COVID-19 diagnosis, and COVID-19 vaccination administration fees for uninsured patients. This reimbursement is available without regard to the uninsured patient’s immigration status through the Health Resources and Services Administration (“HRSA”) COVID-19 Uninsured Program.

Healthcare organizations need to think strategically about navigating the next era in healthcare. Connect with Sunlit Cove Healthcare leaders who can help you stay ahead. Contact us or give us a call at 727.576.2903 to get started.

Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

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