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Covid test billing
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5/21/2020 @ 4:54:00 PM
Post 1 of 5
I am new to this forum. We just started billing for the covid test and I am looking for assistance on how to bill to Medicare and Medicaid. Any help would be greatly appreciated.
7/15/2020 @ 12:45:00 PM
Post 2 of 5

Contributor: Lester Jahnig, Pioneer Memorial Hospital & Health Services

I do not see an answer to this and am now in the same boat as we are now able to run covid tests out of our RHC.  If we can bill it in the RHC do you need the normal face to face visit or now virtual visit?  Most of our tests for covid are drive up now and they are nurse visits only. 

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Last Post By: Melissa Moak, Marion Diagnostic Center LLC

I am new to this forum. We just started billing for the covid test and I am looking for assistance on how to bill to Medicare and Medicaid. Any help would be greatly appreciated.

7/15/2020 @ 1:17:00 PM
Post 3 of 5

Contributor: Nathan Baugh, National Association of Rural Health Clinics

Unfortunately, RHCs cannot bill Medicare for Covid testing if the service does not meet the RHC encounter definition (which if it a nurse visit-only would not qualify). 

The costs of specimen collection/Covid testing are considered allowable costs for RHCs, but do not generate billable encounters. 

We have asked CMS to consider allowing RHCs to bill for Covid testing through a methodology similar to how we bill for Chronic Care Management or Virtual Care Communications but it may be some time before that solution comes to fruition, (if it ever does).

At it's core, I believe that the real problem is the definition of an RHC encounter which requires face-to-face interaction with a RHC practitioner. More and more, Medicare is paying for services that are neither face-to-face nor with a RHC practitioner, and thus RHCs are either completely unable to bill for the service (such as the case with Remote patient monitoring) or we have to create RHC-specific workarounds that complicate things unnecessarily (Chronic Care Management/Virtual Care Communication).








7/15/2020 @ 2:19:00 PM
Post 4 of 5

Contributor: Lester Jahnig, Pioneer Memorial Hospital & Health Services

Nathan, would a virtual visit count?  Say the practitioner "sees" someone via telephone or virtually and thinks that they need to have the test.  Would that count?  Also how are we to recoup the cost of the specimen collection?   
7/15/2020 @ 4:10:00 PM
Post 5 of 5

Contributor: Nathan Baugh, National Association of Rural Health Clinics

Lester,

A virtual 99211 or 99201 can be billed as a G2025 service and paid the $92.03 (wouldn't count as a visit but would be billable as a telehealth service).

If you can figure out how to both collect specimen from the patient & do a telehealth 99211 service at the same time, it is theoretically a creative way to be able to bill something for the whole interaction. However, I feel like this would be an extraordinarily awkward experience for the patient. Imagine if you swab their nose and then ask them to talk to the nurse that just swabbed their nose through their smart phone (so as to make it a telehealth service) as the nurse walks away. I think most Medicare patients would be very confused.

If you are simply doing specimen collection and you are an uncapped RHC, you will be paid at the end of the year when you settle your cost report.

If you are in a capped RHC, unfortunately, you aren't really being paid for specimen collection (outside of the $49k for RHC testing) because you are probably already at the max payment per visit.

Nathan Baugh
Director of Government Affairs
National Association of Rural Health Clinics
1009 Duke Street
Alexandria, VA 22313
(202) 543-0348


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