Tag: #COVID19

Posted in MVP (NY/VT) Insurance Payer, Training, Updates

MVP (NY) COVID-19 Vaccine Proper Billing and Coding guidance

Posted on by KR2Medical Billing

The following medical billing and coding Guidance, for COVID-19 vaccines, ONLY applies to New York Providers.

As per MVP: ALL COVID-19 vaccines are covered for all PLANS without a member cost-share.

In order to get reimbursement, providers need to follow the proper COVID-19 vaccine billing and coding guidance.

For MVP Medicare Patients:

Providers please bill Medicare Fee-for-Service (FFS) directly for the vaccine and administration of the
vaccine to MVP Members enrolled in Medicare Advantage in 2020 and 2021. If Providers will bill the COVID-19 claims to MVP, they will be denied.

For MVP Commercial and Managed Medicaid Patients:

Since COVID-19 vaccines are provided by the government at no charge, Providers should not bill the Vaccine codes (please see below Picture 2). Instead providers should only bill the administration codes (see below Picture 1).

(Picture 1)
(Picture 2)

MVP will reimburse both In Network and Out of Network providers.

Posted in Insurance, Training, Updates

EmblemHealth (NY) COVID-19 Vaccine and Monoclonal Antibody Infusions Policy

Posted on by KR2Medical Billing

Effective 11/09/2020 the following are the guidelines for COVID-19 Vaccine and Monoclonal Antibody Infusions for various EmblemHealth Product lines:

  1. Commercial Plans- EmblemHealth will cover the costs that are associated with administration of COVID-19 vaccines, for In-Network and Out-of-network providers, during the national public health emergency period. Reimbursement will be based on CMS published rates. NY state-specific rules may also apply: Please click here for a NY DOH COVID-19 vaccine presentation.
  2. Medicare Advantage Plans- charges for administrating the COVID-19 vaccine should be billed to your local MAC (Part B). The MAC will reimburse claims for Medicare members with no cost share for the remainder of 2020 and through 2021 If the provider will bill the claims to EmblemHealth the charges will be denied and the provider will be informed that the charges need to be submitted to the local Part B MAC. (If you are a provider located in NY the local Part B MAC is NGS- national government services).
  3. Medicaid Plans- EmblemHealth will cover costs that are associated with administration of COVID-19 vaccines, for In-Network and Out-of-network providers, during the national public health emergency period. NY state-specific rules may also apply: Please click here for a NY DOH COVID-19 vaccine presentation.

Partial List applicable to this reimbursement policy:

For the complete policy and the complete list of applicable codes, please click here to visit the policy.

Posted in My services, Training, Updates

NC Primary Care Providers can get paid for COVID-19 testing of Uninsured Patients

Posted on by KR2Medical Billing

On 10/30/2020- NC HHS Department has created an online portal for Primary Providers to submit COVID-19 claims for uninsured patients.

This is a first-come first-serve reimbursement to primary care providers who are providing COVID-19 related primary care services to uninsured individuals living in North Carolina*. Per the federal CARES act.

In order to qualify the provider must be:

  1. Primary Care
  2. Operate in North Carolina
  3. Participate in NC Medicaid Program
  4. Be registered in NCTracks payment portal

AND

Providers must attest to the following at registration:

• Providers have checked for health care coverage eligibility and confirmed that the patient is uninsured. Providers have verified that the patient does not have coverage through an individual, or employer-sponsored plan, a federal health care program, or the Federal Employees Health Benefits Program at the time services were rendered, and no other payer will reimburse you for COVID-19 testing and/or care for that patient

* Providers will accept defined program reimbursement as payment in full

• Providers agree not to balance bill the patient

• Providers agree to program terms and conditions and may be subject to post-reimbursement audit review

Reimbursement:

Providers will receive $150 per eligible visit.

Reimbursement Process:  

1. PCPs should confirm their enrollment as a provider in the NCTracks system. Enrollment can be completed in the portal.

2. PCPs should perform COVID-19 related services (e.g. follow-up care) for patients as usual.

3. PCPs must ensure the patient does not have insurance to be eligible for the program, PCPs should use the NCTracks portal to complete the attestation form to file the claim. Attestation will serve as verification of eligibility.

NCTracks Attestation Form includes the following language:

By submitting this transaction to the NC Department of Health and Human Services, I attest that the service performed is accurately represented as shown, and the patient was uninsured, and the service was a COVID-19 related primary care service. I further attest that claims have been either submitted to the HRSA portal and denied or were not submitted because they were ineligible for HRSA reimbursement. I understand this transaction is a request for payment from CARES Act funding and is subject to audit by the Office of the State Auditor and other oversight organizations.

4. PCPs should regularly file claims in the provider portal. If the claim has been successfully filed in NCTracks and there are still funds available, PCPs will be reimbursed in subsequent NCTracks check writes issued by the Division of Health Benefits.

Official Press Release from NCHHS, please click here!