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  • 1.  Medicaid Coverage for COVID

    Posted 01-08-2021 11:41

    Today I received an email from Missouri Medicaid, which seems to indicate that they have been instructed by CMS to recover all payments made for COVID positive patients.  It seems they expect claims to be filed to the HRSA Uninsured Program, which we elected not to participate with because we felt we couldn't comply with the Terms and Conditions (requiring tracking and reporting use of the funds, similar to the PRF grants).

     

    I can't find anything from CMS on this, and the email doesn't provide a more specific reference to the origins of this demand.  It doesn't make sense that Medicaid wouldn't cover COVID.  Does anyone have further info on this topic?  Are other states doing this? 

     

    Thanks

     

    Dave

     

           David Smith, FACMPE  |  Executive Director  |  785.393.8387

    5800 Foxridge Dr.  Ste 240  |  Mission, KS  66202  |  www.uickc.com

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  • 2.  RE: Medicaid Coverage for COVID

    Posted 01-08-2021 13:53
    The claims submitted to HRSa are denied when a patient has insurance.
    This is from the HRSA website:

    Providers must verify and attest that to the best of the provider's knowledge at the time of claim submission, the patient was uninsured at the time the services were provided. For claims for COVID-19 testing and testing-related items and services, this means that the patient did not have coverage through an individual, or employer-sponsored, a federal healthcare program, or the Federal Employees Health Benefits Program. For claims for treatment of positive cases of COVID-19, this means that the patient did not have any health care coverage. For claims for vaccine administration, this means that the patient did not have any health care coverage. Providers may submit a claim for uninsured individuals before Medicaid eligibility determination is complete. However, if the provider learns that the individual is retroactively enrolled in Medicaid as of the date of service, the provider must return the payment to HRSA.

    Providers must verify and attest that to the best of the provider's knowledge at the time of claim submission, the patient was uninsured at the time the services were provided. For claims for COVID-19 testing and testing-related items and services, this means that the patient did not have coverage through an individual, or employer-sponsored, a federal healthcare program, or the Federal Employees Health Benefits Program. For claims for treatment of positive cases of COVID-19, this means that the patient did not have any health care coverage. For claims for vaccine administration, this means that the patient did not have any health care coverage. Providers may submit a claim for uninsured individuals before Medicaid eligibility determination is complete. However, if the provider learns that the individual is retroactively enrolled in Medicaid as of the date of service, the provider must return the payment to HRSA.

    Hope this helps.




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  • 3.  RE: Medicaid Coverage for COVID

    Posted 01-08-2021 13:56

    That is helpful!  Thanks

     

    Dave

     

     

           David Smith, FACMPE  |  Executive Director  |  785.393.8387

    5800 Foxridge Dr.  Ste 240  |  Mission, KS  66202  |  www.uickc.com

    p-uic-horizontal-03a

     

                                                              Member of

     

                             

     




    Original Message


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