The Coronavirus Aid, Relief, and Economic Security (CARES) Act was created to provide healthcare resources required to fight COVID-19. The Act was designed to give quick and direct economic assistance for US workers and their families, small businesses and to preserve jobs.

Under the CARES Act, private health plans had to remove co-pays, deductibles and claim denials for COVID-19 related diagnostics and care extended to patients.

But, the data from XIFIN Inc. reveals that some payers continue to charge co-pays and deductibles and deny eligible claims related to COVID-19, especially for the serology test for antibodies.

According to the XIFIN claim data of March and the beginning of April, there has been an approximately 22 percent improper denial rate. It has been managed with most payers and has brought down to approximately 8 percent. Half of this can still be resolved with a phone call. The rest of them must go through an appeals process.

Improper denials pose a major challenge for the COVID-19 antibody tests. In the month of March and the beginning of April, there has been an approximate 43 percent improper denial or mispayment rate. This has been brought down to approximately 25 percent but some amount of work is still to be done there.

Laboratories can lower denial rates by being prompt in calling payers and educating them about the CARES Act and ask them to reprocess claims. This usually results in corrective action to the adjudication system for future claims.

Cases where payer reimbursement for the COVID diagnostic test are below the Medicare reimbursement rate, labs have to connect with the payer’s contracting department to negotiate a rate specific to COVID-19 testing.

One issue that stays unresolved is the Blues payers’ policy to directly pay the patient for out-of-network (OON) claims. Most providers still aren’t too keen to generate billing to COVID-19 patients to avoid CARES Act compliance risk.

However, the Blues, interpret the CARES Act requirement to not bill a COVID-19 patient as strictly applicable to co-insurance and deductible. But the Blues payers insist that labs should bill the patient directly when Blues pay the patient.

Another serious issue is reimbursement for COVID-19 tests that are a part of back-to-work testing. An announcement in June mentions that payers will not have to cover COVID-19 screening tests required by employers when they might need to bring employees back to work.