It’s the end of the Public Health Emergency (PHE) as we know it! Under the PHE, private and government health insurers could not apply any cost-share amounts (co-pays, co-insurance, deductibles, etc) for COVID testing, COVID vaccines, certain treatments, or anti-viral drugs such as Paxlovid. Starting May 11, 2023, however, some of these COVID-related services will be changing.
So what do you need to be aware of?
At the end of the PHE, Medicare Beneficiaries Cost Share will be reinstated. Meaning, COVID testing (at home and otherwise, except when being treated by a doctor to rule out COVID) and COVID treatments except for oral anti-viral drugs such as Paxlovid will now be able to be applied with cost-share amounts.
For Medicaid and CHIP, no cost share will be applied to COVID vaccines or the administration of COVID vaccines for adults and children. Additionally, until the last day of the first calendar quarter one year after the end of PHE (September 30, 2024), no cost-share amounts can be applied.
Finally, Private Health Insurance may reinstate patient cost share and may require prior authorization to cover COVID testing and testing-related services, as well as patient cost share for vaccines and vaccine administration. Private Health Insurance will also no longer be required to reimburse out-of-network providers for COVID tests, testing-related services, vaccines, or vaccine administration.
As we celebrate coming to the end of this Public Health Emergency brought on by the COVID-19 pandemic, we also need to remain aware of the changes that will come with it. But with PractiSynergy, you don’t need to spend your time being vigilant over these changes or focusing on getting every detail right. We handle all things medical-billing and coding so that you can spend your time on what matters most, your practice and your patients.