New Provider Requirements for Pricing of Diagnostic Testing

Thoughtware Alert Published: Apr 01, 2020
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Section 6001 of the Families First Coronavirus Response Act requires private health insurance to cover testing for the SARS-CoV-2 virus and the incidence of COVID-19 (COVID-19) without imposing cost sharing, e.g., deductibles, coinsurance or copayments, for the duration of the public health emergency. This coverage includes the cost of administering approved tests and related visits to healthcare providers.

Section 3202 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) expands on the provisions of the Families First Coronavirus Response Act and outlines the requirements for diagnostic testing pricing, effective March 25, 2020.  

  • Providers will be required to make their cash price for diagnostic testing for COVID-19 public on their websites. 
  • The U.S. Department of Health & Human Services Secretary may impose a $300 penalty per day on any provider of a diagnostic test for COVID-19 that fails to make public the cash price of the diagnostic test on its website.  

For group health plans or health insurance issuers providing coverage for COVID-19 diagnostic tests, §3202 outlines provider reimbursement rates for the diagnostic tests.

  • Provider rates that were negotiated with plans or issuers prior to the public health emergency declaration will remain in effect throughout the declaration period. 
  • Providers that don’t have a negotiated rate with plans or issuers will be reimbursed the cash price listed on their website or may negotiate a rate with the plans or issuers for less than the cash price. 

Due to the rapidly changing information regarding COVID-19, all guidance contained in this article is current as of the date of publication. For more information, reach out to your BKD Trusted Advisor or use the Contact Us form below.

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