Another Day, No Rain. No, you are not the only one. No OHCA members reported receiving payments today from the state Coronavirus Relief Fund through the Office of Budget and Management, nor has the state made any announcement about what happened. DeWine Administration officials informed us beginning late last week that payments most likely would be made Tuesday. Also there does not seem to be any movement on errors (missing providers) or non-matching applications, at least nothing that has been communicated. OHCA will continue to seek clarification and action from the state.
ODH Issues List of SNF Testing Reminders. The Health Department posted the following notice this morning on the Enhanced Information Dissemination and Collection (EIDC) system:
State-Supported Nursing Home Staff Testing – Specimen Preparation and Pick-Up Notes:
1. You MUST complete your lab requisition forms electronically.
a. All forms created through he ODH poral MUST have a unique barcode generated for patient, each test. Please DO NOT TRY TO EDIT the form after the barcode has been generated, as a new barcode is needed for each person for each round of testing to make sure the lab has the information it needs to process the specimens. We are working on IT enhancements to alleviate this administrative load. Please stay tuned for updates in the coming weeks.
b. Moving forward, handwritten forms or electronically altered forms will result in specimen denial by the labs and/or lab charges being billed directly to the facility.
2. Each specimen must be accompanied by a paper lab requisition form.
a. Forms can be placed in the small pocket on the outside of the biohazard bag.
b. If your biohazard bag does not have an external pocket, please double bag the specimen and place the requisition in the outside bag. Staple the bags together with the paper inside.
3. Please be prepared to tell the Ohio National Guard how many specimens you are giving to them when they arrive for pick-up.
SNF Billing Considerations for COVID-19 Testing. Around the state, SNF providers are beginning to receive the point-of-care (POC) machines for rapid COVID-19 testing. OHCA would like to provide some clarification on billing rules for COVID-19 tests in SNFs. First of all, COVID-19 tests of SNF residents during a skilled stay are included in consolidated billing and are not separately reimbursable (please see Interim Final Rule CMS 1744 and corresponding frequently-asked questions (FAQ)).
SNFs otherwise may bill for POC testing:
- The two tests available (Sofia SARS Antigen FIA manufactured by Quidel Corporation and Veritor System for Rapid Detection of SARS-CoV-2 manufactured by Becton, Dickenson and Company) are both categorized by CPT code 87426.
- Since SNFs that receive POC units must be Comprehensive Laboratory Improvement Amendments (CLIA)-waived providers, they will bill this code with a QW modifier. Please see this MLN Connects article for additional information.
- Pricing for this code is set by CGS and does not appear on the regular fee schedules. We confirmed with CGS that their universal rate for this code is set at $35.33 per test
- Some commercial insurance carriers already have published reimbursement amounts, such as Aetna who published that they cover this code and reimburse at $45.23 per test. OHCA has reached out to several other major commercial plans, as well as the Ohio Department of Medicaid, to clarify coverage and reimbursement.
- The SNF may not bill for a specimen collection fee.
In relation to tests sent to laboratories for processing:
- Only specimens collected by a laboratory technician can be reimbursed for a specimen collection fee, and the fee can be billed only by an independent laboratory (please see Interim Final Rule CMS 1744 and corresponding FAQ).
The lab can bill for tests of non-skilled residents and be reimbursed. If the resident has no payor coverage, the lab should bill the uninsured program (please see Health Resources and Services Administration (HRSA) FAQ on COVID-19 Uninsured Claims).