INSURANCE UPDATES
Several insurance providers have updated their billing guidelines to coincide with the extension of the Public Health Emergency (PHE) period, which is now July 20, 2021.
CIGNA
The cost-share waiver for COVID-19 testing, screening or diagnostic services will end on the last day of the PHE period. Cigna has also extended accommodations related to provider credentialing, authorizations and virtual care.
Reminder: the cost-share waiver for COVID-19 related treatment(s) ended on date of service February 15, 2021. For any dates of service after, cost-share applies.
For COVID-19 vaccines, Cigna is covering the cost without any cost-share, when done by any in-network or out-of-network provider. Currently, since the vaccines are being provided by the federal government, only the vaccine is being reimbursed; however, this is subject to change once providers and/or facilities begin purchasing the vaccine.
For additional information, including detailed information about Cigna’s response to COVID-19, visit: https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html
UNITED HEALTHCARE
UnitedHealthcare will cover COVID-19 testing and testing-related services with no cost-share throughout the duration of the PHE, when ordered by physician or other licensed health care provider. Currently, there are no COVID-19 treatment cost-share waivers in effect for Individual Exchange, Individual and Group Market fully insured plans. For Medicare Advantage plans, cost-share waivers for the treatment of COVID-19 ended on date of service March 31, 2021.
UHC covers the COVID-19 vaccine administration with no cost-share for in-network and out-of-network providers during the National Public Health Emergency. Additional services furnished at the same time are subject to copays, deductibles, coinsurance, etc. according to the patient’s benefit plan. Healthcare professionals should not charge members for the post-vaccination observation period.
For detailed information regarding COVID-19 billing guidelines, visit: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2020/covid19/UHC-COVID-19-Provider-Billing-Guidance.pdf
AETNA
Aetna is waiving copays for in-network telehealth services for primary care visits through the end of the Public Health Emergency but not for specialist telehealth services. Effective January 31, 2021, cost-share waivers for specialists visits expired and the members are now responsible for the same cost as in-person office visits.. The cost-share waivers for commercial plans ended on January 31, 2021 as well.
Aetna is also covering the COVID-19 vaccines with no out-of-pocket costs, regardless of in or out-of-network status of the provider or pharmacy. All Aetna members, including commercial and Medicaid plan members will not be subject to any costs related to the COVID-19 vaccines that have received FDA Authorization.
Additional information related to COVID-19 guidelines can be found here: https://www.aetna.com/health-care-professionals/covid-faq/billing-and-coding.html.html or https://www.aetna.com/health-care-professionals/covid-faq/vaccines.html.html
CENTERS FOR MEDICARE & MEDICAID SERVICES
All COVID-19 related tests, including diagnostic testing and antibody testing, and FDA-authorized vaccines are covered by Medicare with no out-of-pocket costs for the member(s). However, the claims should be billed with new COVID-19 vaccine codes and sent directly to Original Medicare. In addition, authorization requirements will be waived for any claim that is received with the specified codes. This also includes non-participating providers.
When billing Medicare for the COVID-19 shot administration, providers are able to bill single claims or submit claims on a roster for multiple patients. Since the COVID-19 vaccines are currently provided by the federal government without charge, providers cannot receive payment for the vaccine.
All COVID-19 billing guidelines can be found on the cms.gov website: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
About PGM
Physicians Group Management (PGM) is one of the fastest-growing medical billing companies in the United States. For over 35 years, PGM has been providing medical billing and practice management services and software to physicians, healthcare facilities, and laboratories. PGM’s current client base encompasses the full spectrum of medical specialties, including Internal Medicine, Dermatology, Plastic & Reconstructive Surgery, Pathology, EMS & Ambulatory Services, Cardiology, Nephrology, Urology, Pain Management, OB/GYN, Gastroenterology, Independent Laboratory, and many more. PGM’s medical billing and practice management solutions include:
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– Laboratory billing software that offers best-in-class systems to streamline, and manage and track, financial and administrative processes