Tiny fraction of $2 billion federal uninsured COVID-19 testing funds have gone out

Only $10.8 million, or 0.5%, of the $2 billion Congress set aside to help providers pay for COVID-19 testing for uninsured patients has been approved to be paid during the first two weeks of the program's operation, according to the most recent government data.

While other HHS grant funds are essentially prospective payments, the uninsured reimbursement program is dependent on providers submitting claims. Several sources that work with providers said the Health Resources and Services Administration has been processing claims promptly, but slow distribution could be caused by coding issues, a lack of awareness about the program, and early technical issues with the HRSA portal.

Lawmakers set aside $1 billion to pay providers for COVID-19 testing for the uninsured in the Families First Coronavirus Response Act, which passed in mid-March, and another $1 billion in the Paycheck Protection and Health Care Enhancement Act, which passed in late April.

Congress didn't set aside any funds specifically to pay for COVID-19 treatment, but the Trump administration decided to use some of the $175 billion provider relief fund lawmakers created for uninsured treatment reimbursement. HHS has refused to say how much money is set aside to pay for treatment reimbursement, but the payments are subject to funding availability.

The HRSA system opened for claims submission on May 6, and the agency said it started sending reimbursement to providers on May 18. An HRSA spokesperson said claims are processed daily on a rolling basis.

According to the most recent publicly available data, HRSA has approved $10.8 million in testing claims and $82 million in treatment claims as of June 2. The agency has approved 31% of the submissions it received as of June 2, the HRSA spokesperson said, though some claims that are pending will not be approved.

Several factors are contributing to the slow pace of funds going out to providers.

Nancy Jones, senior consultant at JW Healthcare Consultants, said some providers she works with weren't aware the reimbursement for uninsured patients was available, and others had issues with coding their claims correctly to ensure they were eligible for reimbursement.

"Unless someone in the practice or organization is paying attention and navigating the waters of the various payment opportunities under the CARES Act, there will be missed opportunities," Jones said.

If claims are incorrectly completed or coded, providers can resubmit the claims for reprocessing.

Democratic staff for the House Ways & Means Committee is looking into potential issues with reimbursement only being available if providers bill COVID-19 as the primary diagnosis for the claim, a spokesperson said.

The American Clinical Laboratory Association, which includes members such as testing giants LabCorp and Quest Diagnostics, said some of its members had technical issues early on with the HRSA portal and had to file claims manually. However, ACLA President Julie Khani said many of the issues have been resolved.

"Laboratories have performed tens of millions of COVID-19 tests eligible for reimbursement through the uninsured fund, so resolving these technical issues and streamlining the claims submission process is critically important," Khani said in a statement.

A HRSA spokesperson said that providers having issues with the electronic claims submission process should reach out to UnitedHealth Group for assistance.

"When ACLA indicated that some of their members were not able to successfully upload claims, UHG immediately reached out directly to those members with customized technical assistance and those members were then able to upload claims," the HRSA spokesperson said.

Some providers have been able to successfully use the portal. Presbyterian Hospital in New Mexico was one of the providers that jumped on the opportunity to apply for reimbursement for COVID-19 testing and treatment.

The hospital already has more financial challenges than many others because of the state's low rate of private insurance, Presbyterian Healthcare Services Chief Operating Officer Clay Holderman said. New Mexico had the lowest rate of private health insurance in the U.S. in 2018, according to Census Bureau data.

The hospital stood up a large COVID-19 testing operation in early March, and Holderman said leadership recognized that the pot of money for testing reimbursement is finite so they applied quickly.

"All health systems are under cash-flow pressures, and beginning that payment flow is one of the main reasons we submitted," Holderman said.

Presbyterian had to go back and re-code some claims to ensure they fit the HRSA guidelines because coding practices have evolved over the course of the COVID-19 pandemic, Holderman said.

HRSA has so far approved $101,605 in testing claims and $640 in treatment claims from Presbyterian, per the June 2 data. Holderman said some additional claims are being reprocessed, and others are pending approval.