As part of the Cares Act legislation, The Department of Health and Human Services (HHS), will provide claims reimbursement to health care providers for testing, treatment, and vaccine administration to the uninsured patient population. More than $5.6 billion dollars have been paid to date and over 238,000 health care providers have enrolled in the program.
In addition, the COVID-19 Coverage Assistance Fund (CAF), launched this week. The COVID-19 Coverage Assistance Fund (CAF) will cover the costs of administering COVID-19 vaccines to patients whose health insurance doesn’t cover vaccine administration fees, or does but typically has patient cost-sharing. Patients cannot be billed directly for COVID-19 vaccine fees, or for the cost to health care providers. Now, underinsured patients will be fully covered through the CAF funds, subject to availability.
How It Works
HHS intends for the two programs to incent providers to get more shots in arms. Providers have funding available to cover the cost for underinsured patients through the CAF funds, subject to availability. Eligible providers will be reimbursed at Medicare rates for vaccine administration fees, and for any patient cost-sharing related to vaccinations, including:
To qualify for reimbursement, providers must adhere to the following steps:
- Enroll as a provider participant
- Check patient eligibility in the EHR
- Submit accurate patient information via the HRSA web portal
- Submit correct procedural and vaccination codes
- Submit claims electronically
- Set up a direct deposit / an ACH account with Optum Pay
What You Need
HRSA has contracted with UnitedHealth Group to be the sole administrator of the HRSA COVID-19 Uninsured Program. There are several steps in the process to get started. First, you must set up and validate a temporary identification number (TIN) with Optum Pay. If you are already registered as a provider with Optum Pay, use your existing One Healthcare ID to sign in. If you do not have a One Healthcare ID, you can register for one on the United Healthcare portal. You will be provided with a unique provider identifier for the HRSA COVID-19 Uninsured Program Portal.
Once registered, provider organizations will need to confirm that the patient was uninsured at the time the services were rendered. The steps in the claims reimbursement process include:
- Provide accurate patient demographic information
- Access the web portal to submit patient information
- Obtain a temporary member ID
- Manage and add patients individually, or as a batch
- Submit claims for reimbursement
- Receive electronic deposit within 30 days
Automation Simplifies the Process
Because all submitted claims must be complete and final, accuracy is an important detail. There will be no adjustments to payment once reimbursements are paid. Automation allows the hospital and/or provider organization to review the patient information, and ensure all of the information being added is accurate and complete before submitting via any of the web authorization portals. By using automation, or a “digital workforce,” to complete these steps, the burden of manual data entry between the EHR and the HRSA web portal is removed. Automation navigates through the following steps:
- Review patient information for coverage and eligibility in the EHR
- Capture the necessary information for claims submission
- Navigate to the web portal via a web browser
- Apply for the TIN (Temporary ID Number)
- Wait for the approval process (24 hours)
- Send any documentation and/or notes back to the EHR
- Ensure timely filing and submit claims for filing
Automation eliminates 12-20 time consuming and manual steps between the EHR, payer authorization portals, and the HRSA program portals. Automation ensures accuracy, which is an important factor of the HRSA COVID-19 Uninsured Program. If a claim is submitted with a potential error, the claim is returned to the provider, delaying the reimbursement process and creating the need to repeat the claims processing steps.
Why Boston Software Systems?
Robotic Process Automation (RPA) has a pivotal role in helping these programs operate effectively and efficiently. If your hospital or provider organization is looking to optimize day-to-day operations, go with a global leader in healthcare-specific RPA.
At Boston Software Systems we have worked with multiple client hospitals on the COVID-19 claims reimbursement process. KLAS reviewed and customer validated, we can have this deployed quickly and without disruption to people or existing infrastructure.