COVID 19 Diagnostic Testing

03/30/2020

GPAC SPOTLIGHT 03/30/2020-CARES ACT Link/FACT SHEET REGARDING ADVANCE PAYMENT FOR PROVIDERS/ACTION REQUIRED FOR THOSE PROVIDING COVID 19 DIAGNOSTIC TESTING

The ‘‘Coronavirus Aid, Relief, and Economic Security Act’’ or the ‘‘CARES Act’’-https://www.congress.gov/116/bills/hr748/BILLS-116hr748enr.pdf

Highlights from the CARES act-

SEC. 3202. PRICING OF DIAGNOSTIC TESTING.

(a) REIMBURSEMENT RATES.—A group health plan or a health insurance issuer providing coverage of items and services described in section 6001(a) of division F of the Families First Coronavirus Response Act (Public Law 116–127) with respect to an enrollee shall reimburse the provider of the diagnostic testing as follows:

(1) If the health plan or issuer has a negotiated rate with such provider in effect before the public health emergency declared under section 319 of the Public Health Service Act (42 U.S.C. 247d), such negotiated rate shall apply throughout the period of such declaration.

(2) If the health plan or issuer does not have a negotiated rate with such provider, such plan or issuer shall reimburse the provider in an amount that equals the cash price for such service as listed by the provider on a public internet website, or such plan or issuer may negotiate a rate with such provider for less than such cash price.

(b) REQUIREMENT TO PUBLICIZE CASH PRICE FOR DIAGNOSTIC TESTING FOR COVID–19.—

(1) IN GENERAL.—During the emergency period declared under section 319 of the Public Health Service Act (42 U.S.C. 247d), each provider of a diagnostic test for COVID–19 shall make public the cash price for such test on a public internet website of such provider.

(2) CIVIL MONETARY PENALTIES.—The Secretary of Health and Human Services may impose a civil monetary penalty on any provider of a diagnostic test for COVID–19 that is not in compliance with paragraph (1) and has not completed a corrective action plan to comply with the requirements of such paragraph, in an amount not to exceed $300 per day that the violation is ongoing. If you are planning to test and bill for Covid-19 you must publish your cash price on your website. Here is the pricing the I received from the attached AC COVID lab test pricing

MAC

Jurisdiction (J)

MAC States/Territories

U0001 Test Price

U0002 Test Price

J6 – National Government Services (NGS)

Illinois, Minnesota, Wisconsin

$35.91

$51.31

JK – National Government Services (NGS)

Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

$35.91

$51.31

JH – Novitas Solutions

Arkansas, Colorado, New Mexico, Oklahoma, Texas Louisiana, Mississippi

$35.92

$51.33

JL – Novitas Solutions

Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania; Part B services include Arlington and Fairfax counties in VA, and the city of Alexandria, VA

$35.92

$51.33

JN – First Coast Service Options (FCSO)

Florida, Puerto Rico, U.S. Virgin Islands

$35.92

$51.33

JJ–Palmetto Government Benefits Administrators (PGBA)

Alabama, Georgia, Tennessee

$35.91

$51.31

Below are links to a couple of articles that may be useful. There is also a link to the AMA for additional resources.

Special Coding Advise