With reimbursement changes looming, questions surround future COVID testing

September 9, 2020

The following is a column from Vachette CEO Mick Raich:

Several questions surrounding COVID-19 testing and reimbursement for the fall of 2020 make us all stop and think. First and foremost, what happens if the public health emergency ends on Oct. 23? Remember, were many changes implemented when this was enacted; rules about non billing of patients for COVID diagnoses, special portals implemented by payers — all these changes are meant to be temporary. So, what happens next? 

How then are we going to move forward? Are employers going to continue to mandate medical testing for certain healthcare employees and who will pay for it? Remember, many payers now say mandated employee testing is not a medical necessity. Will insurances stop paying for these tests once the public health emergency is over? What about payment for previously waived co-pays and deductibles paid through the insurance portals? Will COVID testing become the new normal and how will this affect the overall cost of healthcare? 

Remember, while Medicare reimbursement for COVID-19 testing is currently set at the MAC level, CMS is looking to establish national payment rates for these tests with the release of the next Clinical Laboratory Fee Schedule (CLFS). This means a reduction of the $100 payment for high-throughput testing should be expected, although to what extent it may be reduced is unknown. With testing supply increasing to meet demand, expect the price to lower. 

Given these circumstances, here are my thoughts on how will we move forward: First the public health emergency will be carried on through the election and remainder of the year. Then, it is likely it will be removed.  Will healthcare employee testing still be mandated? Yes, absolutely, we are likely not coming back from this type of testing. It will be the norm.  

Will insurances eventually stop paying for rampant testing? Again, I strongly believe this will happen. Many commercial payers had their best-ever quarters in the second quarter of 2020. I think they will continue to tighten things down, which means paying for COVID testing on a mass scale is likely not on their to-do list as it doesn’t make them money. 

I do believe the copay and deductible forgiveness plans will continue for a while, likely until fall of 2021.  

It is likely COVID testing will be the norm going forward for a long, long time. Seen things cannot be unseen. This is now part of the broadly accepted national narrative; we could be wearing masks for a long time, also. I do not think it is politically possible to step back from these tests at this point. 

In the end, perhaps the bigger question, is how will health systems survive another potential shutdown and how will the pending inflation and federal interest rate hike slow down the potential healthcare research which may be needed to prevent these pandemics going forward?  

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