End of An Era? COVID-19 Emergency Declaration End Dates Announced

The federal administration has signaled that they plan to officially end the COVID-19 national emergency declarations on May 11, 2023. This indicates the danger and impact of COVID-19 have reached a manageable level that no longer warrants the same level of control and funding available since the CARES Act was passed. While the May 11 date may change, you should assume that the protections and funding will see significant changes around that time and plan accordingly.

Unlike the end of the HRSA claim filing program in 2022, providers have early warning and time to plan. It is essential for your leadership and operations teams to understand the implications of these changes and take steps in the near term to protect your organization.

How will this impact my Revenue Cycle program?

As a result of this change, the government has announced the end to the direct funding of COVID vaccines and tests. This may have an impact on state-sponsored financing as well. Commercial payers and even municipal programs will adapt their billing and payment provisions as these changes flow down to federal and state agencies.

While we believe that COVID-19 diagnostic testing will continue to be needed and funded by insurance carriers, the medical necessity evaluation and billing rules will see increased scrutiny, similar to that of influenza testing today. We anticipate payers and providers will begin to look for combination testing and vaccination products such as flu panel tests capable of detecting influenza A & B as well as COVID variant detection. Increased cost pressure will likely occur to make antigen testing a higher-access, lower-cost primary solution.

Additionally, Section IIIA of the CARES Act will impact your RCM operations’ effectiveness. That section states:

“Section IIIA of this rule provides that all health plans covered under the Employee Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue Code must disregard the period from March 1, 2020, until 60 days after the announced end of the national emergency or such other date announced by the agencies in a future notification (the “Outbreak Period”) in determining time limits for certain activities including the dates to file a claim or an appeal for all plan participants, beneficiaries, qualified beneficiaries, or claimants....”

Based on this rule, payers must continue to reimburse providers for pandemic-related claims until 7/11/2023. Beyond this date, timely filing limits may be reinstated.

What Action Do I Need to Take Now?

Here are our recommendations to make sure you’re well-prepared and positioned for this transition:

• Maintain Regular Business Operations: We strongly encourage all COVID-19 lab and vaccination services providers to continue regular operations and billing activities appropriate to the care being provided. While performing your RCM operations, you may want to ensure your billing operations are accelerating activities to ensure claims are filed timely and appeals are responded to promptly. In addition, we recommend the following:

• Clear Your Old AR: We suggest that you focus your effort between now and 60 days after the official end of the emergency protections on ensuring all old AR is billed to the appropriate payers. As payers will likely remove the protections against timely filing, it is vital to ensure all claims are submitted promptly within standard filing windows and that your RCM operations prioritize requests for information and denial responses based on appeal windows.
  
  
• Focus On COB Denials: Any uninsured patients or claims with invalid/incomplete insurance information should be reviewed quickly and scrubbed for insurance. You should evaluate the processing Coordination of Benefit (COB) Denials as well since most of these denials can be remediated with an eligibility solution that has advanced COB detection.
  
  If your eligibility solution does not have this feature, don’t hesitate to contact Wave HDC to discuss a clean-up project on these denials --- do not wait until the last minute!
  
  
• Determine Your HRSA Recoupment Exposure: We are very concerned about the implications this will have related to HRSA assessment actions. As many providers have already been contacted about sample assessments, findings show that the federal government paid 20-40% of HRSA-paid claims inappropriately.
  
  We anticipate that many providers will see large recoupments and corrective action plans resulting from standardized TPL auditing over the next 12 months.
  
  Providers who have not already screened their HRSA paid and unpaid claims through a competent insurance discovery solution should prioritize this immediately. Once completed, any identified claims should be billed to the correct entity before the timely filing protections are removed, as there is no assurance that payers will allow these claims to be adjudicated or paid if filed after the recoupment.

We’re Here To Help!

If you would like to connect to discuss the impact of these federal changes or how we can assist your organization in mitigating the risk while increasing your revenue, please feel free to reach out to me directly.

David “Fig” Figueredo
COO, Wave HDC

Email Fig