Beyond the COVID public health emergency: How to avoid reimbursement delays

As President Biden announced earlier this year, the COVID public health emergency is ending May 11. Though the pandemic and related National Health Emergency (NE) and Public Health Emergency (PHE) will soon become history from a policy perspective, the financial ramifications for healthcare providers will linger much longer.

Has your facility been fully reimbursed for the costs of COVID-19 treatments and vaccines? If not, how will you secure reimbursement after the federal emergencies expire?

Understanding the impact of expiring federal COVID-19 funding

Extended coverage for COVID-19-related care has made the distribution of medications and vaccines relatively worry-free – providers simply had to submit a reimbursement request directly to the government. But that’s all coming to an end.

These COVID public health emergency declarations have been in place for nearly three years, enabling the government to modify certain coverage requirements by Medicare, Medicaid, and private insurance plans.

Once the public health emergency expires, patients become responsible for paying the bill. After May 11, many providers, including pharmacies and labs, will need to find a way to identify new billable insurance and recover payments on their own.

For example, when a lab distributes a COVID-19 booster after May 11, they must bill the patient directly, either getting payment at the time of service or submitting a claim to a payer for reimbursement. Private insurers, Medicaid, and Medicare will now all have different coverage and co-payments surrounding COVID-19-related treatments – which will create more headaches for providers’ billing departments since there will no longer be regulatory compliance or federal funding for how these treatments are reimbursed.

Finding and chasing down patient payments is much more challenging than filing claims to the government or insurance companies. Getting reimbursed completely will take time but can be sped up with the right resources.

Avoid delays in revenue recovery following the public health emergency

Inovalon provides easy-to-use tools that help you maximize reimbursement for COVID-19 tests, vaccines, and medications. On average, our solution returns an insurance identification hit rate of nearly 40% on uninsured accounts¹.

Our Insurance Discovery software reduces uncompensated care and underpayments by identifying active billable coverage previously unknown to the provider.

For example, we worked with a collection agency facing significant delays in reimbursement to help them increase insurance collections by 10%. Instead of sorting through multiple data points to track down payers, Insurance Discovery helped agents utilize batch search capabilities and create dynamic filters to speed up data mining and focus more on those accounts that are eligible for collection. With easy identification of primary, secondary, and tertiary coverage, the collection agents can now find insurance that their clients were unable to identify. As a result, clients have noted improved dollars collected while reducing complaints and improving patient satisfaction.

Enhance your collection strategy with Inovalon

Our innovative SaaS tools are designed to save providers time and headaches while helping you increase margins.

Are you ready to boost reimbursement opportunities by easily determining if patients have multiple active payers?

Don’t go it alone.

Look to your vendors to help you manage this – we have experts in-house to help. Schedule a demo with our team today to learn more.

Source:

1 Inovalon internal reporting, July 2022. Individual results may vary.

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