« Medicare contractors... | Main | Medicare offers addi... »

Thursday May 06, 2021

How to get paid if a patient’s health plan doesn’t cover the COVID-19 shot

Physicians can now request payment for administering the COVID-19 vaccine to patients whose insurance doesn’t cover it. While most health plans are required to cover the cost of administering the COVID-19 vaccine without cost-sharing, there are a few exceptions (such as grandfathered group health plans(www.mercer.com) and short-term individual plans(www.kff.org)).

In the rare event that health plans do not cover vaccine administration, practices are prohibited from balance billing patients for it. Until recently, this left practices in a tough spot, because the Health Resources and Services Administration (HRSA) only provided payment for uninsured patients. But now HRSA has announced a Coverage Assistance Fund (CAF)(www.hrsa.gov) to provide payment for patients whose health plan doesn’t cover the vaccine administration, or covers it but imposes cost-sharing.

To apply for payment through the CAF, physicians must first submit a claim to the patient’s insurance plan. If the claim is denied or only partially paid, physicians can then submit a claim to the CAF Portal(bit.ly) to receive payment. The CAF will provide payment at the Medicare rate.

Additional information is available on the HRSA’s CAF website(www.hrsa.gov), including:

Practices can also still request payment for administering the COVID-19 vaccine to uninsured patients through the HRSA Uninsured Program(www.hrsa.gov).

— Erin Solis, Manager, Practice & Payment at the American Academy of Family Physicians

Posted at 11:45PM May 06, 2021 by Erin Solis

« Medicare contractors... | Main | Medicare offers addi... »


CURRENT ISSUE

RECENT POSTS

SEARCH THIS BLOG


TOPICS

DISCLAIMER

The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.

FEEDS