You get a Covid Home Test, You Get a Test, You Get a Test…

January 21, 2022

Is it your favorite thing yet? Yeah, us too as we get into the fraud piece of this. Last week we shared New Covid Home Testing Reimbursement Rule Could Cause Surge in FWA and a reader messaged us with some extra insight…

“Best option appears to be buy at pharmacy and have claim run as OTC (which use NDC codes to identify the item) where payers allow for certain amount and type of OTC today. It’s still an issue as pharmacies have to treat it as a script and get either approval or denial at point of sale and the payer has to have the script item in their formulary. Even brand matters.

Setting up means payers who honor any OTC today have to add the NDC codes and update claims systems and those who don’t today need to implement the process.  

Another issue is knowing the NDC code to process at the pharmacy. Some items print it otherwise it has to be derived like a secret decoder ring from the UPC barcode. Not everyone can or will bother doing this so then they either reject or make up another that goes through.

Hope this background helps with one option and they don’t even start allowing the paper submission reimbursement path. Ugh for all.”

Paper claims and mail or fax is actually the way it’s going (example). Our own Eric Rubenstein discussed this on the latest episode (16) of the Coffee, Compliance & Chuckleheads podcast. Especially page 2: do not staple or paper clip the bills or receipts to the claim form is his favorite part.

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