Per BPHC, FQHCs are NOT required to participate in the Uninsured Claims Program
Thursday, August 27, 2020
Posted by: OACHC
In an FAQ issued on Aug 20, BPHC stated that FQHCs may participate in the HRSA Uninsured Claims Program, but did not state that they are required to do so. The text of the full FAQ is posted verbatim below and can be found here: https://bphc.hrsa.gov/emergency-response/coronavirus-frequently-asked-questions?field_faq_category_tid=All&combine=uninsured
NEW Are health centers required to participate in the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Test
ing and Treatment of the Uninsured Program (HRSA COVID-19 Uninsured Program)?
In accordance with current Health Center Program billing and collections requirements, health centers must make every reasonable effort to collect appropriate reimbursement for their costs, including billing Medicare, Medicaid, CHIP, and other public and private insurance or assistance programs, as applicable. Health centers must apply their sliding fee discount schedules consistent with their established policies and procedures. For costs associated with testing uninsured individuals for COVID-19 or treating uninsured individuals with a positive COVID-19 diagnosis that are not reimbursed by other programs, health centers may—and HRSA encourages them to—submit claims for reimbursement to the HRSA COVID-19 Uninsured Program.
To participate in the HRSA COVID-19 Uninsured Program, providers must attest that they have checked for health care coverage eligibility and confirmed that the patient is uninsured. Specifically, providers must verify that the patient did not have coverage through an individual or employer-sponsored plan, a federal health care program, or the Federal Employee Health Benefits Program at the time services were rendered, and that no other payer will reimburse them for COVID-19 testing and/or care for that patient.
Health centers that submit claims for reimbursement to the HRSA COVID-19 Uninsured Program are responsible for adhering to all applicable HRSA COVID-19 Uninsured Program requirements, including certain prohibitions against balance billing and reporting requirements. For general information about the HRSA COVID-19 Uninsured Program, view the HRSA webpage or Frequently Asked Questions. For answers to specific questions about the HRSA COVID-19 Uninsured Program, providers should call the toll-free Provider Support Line at 866-569-3522.
Health centers are also reminded that, in accordance with Health Center Program requirements, they must operate in a manner such that no patient shall be denied service, including services related to COVID-19 testing or treatment, due to an individual’s inability to pay (Health Center Program Compliance Manual Chapter 16: Billing and Collections). For additional information, see the related question “Can health centers charge patients for COVID-19 related testing and treatment?” in the Program Oversight and Monitoring section of this FAQ.