The state Department of Health (DOH) has recently updated its state Medicaid billing guidance to explain how Certified Home Health Agencies (CHHA) can bill for COVID-19 specimen collection under fee-for-service Medicaid.
The billing pathways outlined here are effective November 1, 2020. DOH provides codes 4921 and 4922 for specimen-collection and travel when a patient is not already otherwise receiving CHHA nursing services, in which case billing “should be done as part of a nurse visit and is included in the CHHA rate.”
The new guidelines, however, do allow separate billing for CHHA nursing services that are exclusively for the purpose of collecting a specimen from patients. This includes patients who are:
- Already CHHA patients but receive “lower-level services,” labelled as “personal care services” in the DOH guidance (see clarification below).
- Non-CHHA or MLTC “homebound” patients (see clarification below).
Clarifications
HCA has verbally clarified with DOH that “homebound” is not intended as the “Medicare” definition of “homebound” but generally reflects a patient who needs care and testing at home. HCA has also clarified that the reference to “personal care services” is intended to be inclusive of aide services (thus PCA, HHA) and not limited to only personal care worker cases. HCA will be obtaining those DOH verbal clarifications in writing.
Act Today: Enroll in our Home Care Clinician Training
HCA strongly encourages providers to act on this new billing guidance by ensuring your staff are trained to conduct COVID-19 specimen collection services that are reimbursable by Medicaid. If you haven’t done so already, please enroll in our complimentary, grant-funded training program that your nurses can take on-demand at any time, 24-7, through HCA’s “Home Care Clinician Training for COVID-19 Testing.” Simply follow the instructions here to enroll.
We also encourage you to work with other payers and community partners (such as physician practices, hospitals and managed care plans) to notify them of your readiness to help with COVID-19 testing. Please also let them know about the rate benchmarks established by Medicaid fee-for-service in support of this effort.
COVID-19 infection rates are on the rise. COVID-19 specimen collection is a service that your organization can provide for patients who are chronically ill, lack transportation, or risk getting sick and/or exposing others to infection by going elsewhere when they could be receiving the same test at home. Timely testing also supports the safety of your staff. Please act today.