COVID-19 Business Intelligence and Analysis for Clinical Laboratories, Pathology Groups and Hospital Administration

COVID-19 Briefings

Reliable COVID-19 Business Intelligence and analysis for clinical laboratories, pathology groups and Laboratory Diagnostics.

CMS Issues Guidance to Reduce Commercial Payer Denials for COVID-19 Testing

CMS maze of rules and regulations
Share on facebook
Facebook
Share on twitter
Twitter
Share on linkedin
LinkedIn
Share on pinterest
Pinterest
Share on whatsapp
WhatsApp
Share on email
Email
Share on facebook
Share on twitter
Share on linkedin
Share on google
Share on whatsapp
Share on email

New CMS guidance reinforces that commercial payers should cover asymptomatic COVID-19 testing

The US Centers for Medicare and Medicaid Services (CMS) provided new guidance for payers in late February 2021, to reduce potential loopholes that some commercial payers may be using to deny COVID-19 testing claims. Three issues addressed by this new guidance include COVID-19 test claim denials, cost-sharing imposed for individuals that are asymptomatic, and vaccination coverage.

Eight Key Points of the CMS Guidance to Commercial Payers

  1. Payers cannot use medical screening criteria to deny (or impose cost-sharing on) a claim for COVID-19 testing for an asymptomatic individual who has no known or suspected exposure to COVID-19.
  2. Payers can distinguish between testing asymptomatic individuals for medical purposes and screening for workplace health, public surveillance, and other similar types of screening tests.
  3. Payers should cover COVID-19 diagnostic tests “provided through state- or locality-administered testing sites”.
  4. Point-of-care tests should be covered like any other COVID-19 test.
  5. Payers typically have to cover COVID-19 vaccines without cost-sharing.
  6. Payers do have to “cover the vaccine administration fee when the plan or issuer is not billed for the vaccine”.
  7. Payers cannot deny coverage for a vaccine if the person getting the vaccine was not in a category that was recommended for early vaccination.
  8. Payers may not have to cover certain vaccinations that are provided by an employer.

The guidance also clarifies what items and services that plans and issuers are required to cover, that are associated with COVID-19 diagnostic testing (and in various settings), as well as reported areas of noncompliance with CARES Act requirements.

Clinical laboratory leaders wishing to view the guidance in its entirety can do so here.

Related Resource:

CMS: FAQs About Families First Coronavirus Response Act and Coronavirus Aid, Relief, And Economic Security Act Implementation Part 44

 

COVID-19 TESTING DATA

Helping Your Lab Stay Afloat During Challenging Times

Dear Colleague,

Robert L. MichelIn these challenging times for our colleagues in clinical laboratories, pathology practices and hospital administration, The Dark Intelligence Group (TDIG) — through generous grants from our partners — is bringing you the COVID-19 STAT Intelligence Briefings.

We’ve added analysts, writers and skilled editors to the COVID-19 STAT team to uncover, analyze, and immediately report to you what’s happening with the SARS-CoV-2 pandemic, packaged with the insights you need to deliver quality testing for patient care and keep your lab’s financial ship afloat. As part of our mission, we are also bringing you real-time data from our partners around testing that you will not find anywhere else.

Please let me know how we can better improve this service to fit your needs. If you would like to offer a grant to keep our mission going with this site, please contact me at rmichel@darkreport.com.

Sincerely,

Robert L. Michel
President, Founder
The Dark Intelligence Group