Don’t write off those HRSA/COVID claims just yet.
There’s still reimbursement on the table if you can quickly discover why your rejects were rejected.
What can you do with your HRSA claims in suspense, both:
those not yet submitted?
those that have been rejected?
How can you rescue at least something from these claims?
How can you be prepared for looming government audits?
By Stephen Passalacqua
Chief Executive Officer
tevixMD
While the government could always consider an extension for the Health Resources and Services Administration (HRSA)claims under the COVID-19 Uninsured Program, at the time of this writing, it doesn’t appear to be happening. Both the testing and treatment claims deadline (March 22, 2022) and the vaccine administration claims deadline (April 5, 2022) are behind us. The safer way to plan is to accept the inevitable end to the program and any further possibility of reclaiming COVID revenue from HRSA. But there is a way to reclaim revenue after HRSA’s COVID-19 Uninsured Program ends all reimbursements or providers have COVID claims that weren’t submitted.
Are your pending claims in jeopardy of nonpayment?
Getting paid on valid claims that have been submitted on time may be in jeopardy. Take into consideration the following from HRSA:
”The HRSA COVID-19 Uninsured Program and Coverage Assistance Fund are no longer accepting claims due to a lack of sufficient funds. HRSA anticipates that claims submitted by the deadline may take longer than the typical 30 business day timeframe to process as HRSA works to adjudicate and pay claims subject to their eligibility and the availability of funds.”
The caution regarding the potential extended timeframe signals that more recent claims processed are among a “tsunami” of last-minute claims sent by providers in hopes of payment. In addition, “paying claims subject to…the availability of funds,” suggests that the government may cease payments as soon as the money runs out. So reimbursement through HRSA is not certain but taking action now will help rescue the most revenue.
Even without HRSA you can still get paid for COVID claims through payors, BUT the clock is ticking.
It would appear your claims have come to the end of the line. Either they weren’t submitted by the deadlines or they were rejected by HRSA. It seems there’s no means to reclaim that lost testing and vaccination revenue. Or is there?
You can still get paid by turning your attention to payors for reimbursement. You will have to do it quickly. There is a “time bomb” in play and it has been ticking since the patient got their test or vaccine. At this point, the HRSA time bomb has exploded and leaves behind no options for payment. There is another timeline you’re now racing against and that’s the payor’s deadline. Each payor’s schedule will vary so it’s more important than ever to discover which claims can be validated for 3rd party payor submission and get them in right away.
The best way to beat the clock is to have the best in class insurance discovery provider. “Going back and finding insurance for HRSA claims is definitely fertile ground to reclaim revenue that will soon be lost. On average we find insurance on 68% of rejected claims,” says Christina Cuartas, Vice President, Client Success at TevixMD. “And that translates into significant revenue that would have most likely been written-off when there is value in .”
It has been determined that on average of the claims where insurance is discovered 50% or more have value to the provider.
Give claims their best chance of success the second time.
Before embarking in a second process for these problem claims, be sure to submit them to payors in a way that gives the best chance of reimbursement the first time through.
The question to ask before restarting the claim process with payors is “Why have these HRSA claims not been paid to this point?”
There are several reasons claims have been rejected:
Missing/incorrect Insurance information
Inaccurate patient identification
Incomplete patient information
Eligibility errors
Incorrect coding
Duplicate billing
Of unpaid HRSA claims, the number one reason of “failure to launch” or being denied, by far, is invalid patient identification and insurance eligibility verification. In fact, on average 40% of data from providers is found to have missing or invalid patient verification or insurance eligibility. Many of those claims can be fixed with intelligent verification.
We all know that claims do not move forward if patient demographic data is wrong or incomplete. Problems with demographic data happen in three ways:
Portions of demographics are unavailable at the point of service.
Information is written illegibly on the order.
Data is input incorrectly into the EHR
No matter how it happens, the results are unproductive and contribute to further lost revenue and lost time in the form of rework. Therefore, ensuring that patient demographic and insurance data is accurate and complete at this first step is critical in stopping revenue leakage. It can also be a way to circle back to payment options with payors for many HRSA claims.
Secondly, if patient insurance eligibility is not verified simultaneously, then claims are kicked back from HRSA. Verifying insurance eligibility up front will help to further ensure reimbursement. “Going back and finding insurance for HRSA claims is definitely fertile ground to reclaim revenue that will soon be lost. On average we find insurance on 68% of rejected claims,” says Christina Cuartas, Vice President, Client Success at TevixMD. “And that translates into significant revenue that would have most likely been written-off.”
Be sure to define what is acceptable insurance discovery process.
Can the service provider provide:
Automatic patient identity validation?
Complete identity details?
Identity validation at the time of insurance discovery?
Accurate insurance information at the D.O.S.?
The ability to leverage other providers for Insurance Discovery?
Custom payer listings?
Custom number of payers?
48-hour turnaround?
Availability of transactions and process if needed for an AUDIT?
One stop for all services with minimal human input?
Just when you thought it was all solved, it’s not.
Another challenge is quickly ramping up regarding preparation for audits. The Health Resources and Services Administration (HRSA) will be auditing claims with the intent of requesting that funds be returned for submissions that lacked thorough insurance discovery for active third-party coverage. “The recipients of PRF payments may be subject to auditing by HRSA to ensure the accuracy of the data submitted to HHS for payment. Any recipients identified as having provided inaccurate information to HHS will be subject to payment recoupment and other legal action,” according to the HRSA.
As more information becomes available regarding the auditing process, how you prepare for your audit may change. It is safe to say that knowing which claims have third-party insurance will be critical to your exposure, both financially and legally.
There are some questions that need to be answered:
What will the government consider to be adequate insurance discovery?
What recourse will a provider have to return funds?
Can the provider perform insurance discovery retroactively?
Making certain patient demographic information is valid and insurance eligibility is verified at the first step in the process will increase reimbursements on the back end. The best way to do that is to utilize intelligent verification to most accurately accomplish both together and in real time.
tevixMD was founded in 2014 and provides insurance and other patient data through a patented platform of connected services that enables healthcare providers to identify coverage and deductible information for patients to efficiently process claims and get paid. The company was founded to improve the financial performance of healthcare providers and by doing so improve healthcare and patient satisfaction. It's the only platform that provides real-time accurate patient data and insurance/MBI coverage information using minimal patient identification information. Learn more at www.tevixmd.com/contact
Disclaimer: tevixMD is not providing legal advice, we are only providing information on how our solution can help you be compliant with HRSA.