COVID-19 return to work testing: guidance for brokers and employers

The following testing options, pricing, and logistics solutions provide guidance for employer groups wanting to test employees for Coronavirus (COVID-19) when returning to work.

Virus testing approach 1 – minimize insurance plan billing

Private insurance plans provided by employer organizations, and plans that employees might have elsewhere, are all required to pay for COVID-19 testing with no co-pay. This includes out-of-network doctor visits. The most common testing methods with billable codes are nasopharyngeal and oral swab sample collections, which are sent to labs for testing using existing CPT and ICD testing codes, according to CMS and AMA guidance. With proper billing, the total billed cost per employee for COVID-19 testing should be $102.66, where $51.33 is billed by the doctor, and $51.33 is billed by the lab. The total COVID-19 test cost per employee billed to the plan should be $102.66.

Unfortunately, what we are witnessing in the marketplace are the same overbilling practices we see all the time. Health systems and labs work together to bill full respiratory panels at $231, which includes the COVID-19 testing, plus additional unwanted testing when all that is desired by employers is the COVID-19 test for return to work. The medical justifiable reason being that patients might have the regular flu, bronchitis, or other viruses, so they must test for all. You may have even seen news clips of hospitals testing for both at their drive-through centers.

Cost comparison example: Assume testing of 10,000 employees.

• Best case scenario: 10,000 x $102.66 = $1,026,600
• Overbilling scenario: 10,000 x $231 = $2,310,000. This is a 125 percent or 25 times overbilling scenario.
• Potential for $1.284 million in billed cost savings.

Recommendation: Partner with local practices or health care systems to control your costs. Employers and employees should insist on COVID-19 only testing and billing.

Virus testing approach 2 – lab billing with provider flat fees

There is no way to circumvent the DNA PCR lab analysis machines that heat and cool the test swabs to get positive or negative test results. With this option, an employer group uses the labs, but contracts directly with doctors or health care systems and brings them onsite for a flat fee. The practice or health care system performs all testing and swabbing for one flat fee, which eliminates all doctor billing for each test.

The primary argument against mass swab/PCR testing is that you are now putting an unnecessary burden on the labs by testing people that were not showing symptoms and were never exposed. Therefore, results are delayed for those individuals sho are positive and might not be quarantining as soon as they should. For example, test results coming back in 5-7 days instead of 2-3 days due to the increased lab burden.

Related: Short-term health insurers expanding COVID-19 testing coverage

While once a sample arrives at the lab, much less can go wrong with the testing procedure, keep in mind that there are still many possible points of failure in the end-to-end process. Some doctors will also argue that several things can go wrong with lab testing due to human or technological procedural errors, which can lead to false negatives or no reading at all. Some examples cited include the following:

• Medical providers might not obtain testable (good enough) samples
• Lab bags can be mislabeled
• Improper storage of samples prior to shipment to labs
• Shipping issues causing problems if not delivered on time or in a prescribed manner
• Sample mishandling by lab technicians
• Technical or human errors with lab machines leading to incorrect results
• Time delays and inefficiencies in result notifications by labs

Cost comparison: Assume testing of 10,000 employees.

• Lab cost – Employer group still incurs $513,300 in lab costs (10,000 x $51.33 per employee)
• Doctor flat fee cost – A fair flat rate price with doctors taking on the staffing liability and supply purchasing with proficient logistics planning would be about $250,000 for a 7-to-10-day testing event. The doctor is taking a 50 percent pay cut, but they are being guaranteed the volume for all employees.
• Total – $763,300 to the plan ($513,300 + $250,000)

Recommendation: Partner with local practices for agreement on flat fee billing for doctor services. The only service billed to the plan would be the lab charges.

Approach 3 – rapid panel antibody testing

Rapid panel antibody testing is a way to determine if individuals have already made antibodies to the virus. The general medical assumption is that those individuals with these antibodies should be resistant to becoming symptomatic with further exposure to COVID-19, and that they will no longer spread the virus to others. Keep in mind that rapid panel antibody testing is very different from lab-based nasopharyngeal and oral swab testing in purpose, method and procedure.

Also: What’s missing in our country’s coronavirus response?

These rapid panel tests use a finger prick blood sample to determine if your body has made antibodies to the COVID-19 virus, and the results are usually available within 10 to 15 minutes. These tests have EUA FDA authority for clinician use, but they are not considered as accurate as the lab-based swab/PCR testing that is used to determine if individuals currently have the COVID-19 virus. Current clinical testing shows that rapid panel tests are 95 percent to 97 percent as accurate as the lab swab/PCR test, which are the most accurate with no human error.

Rapid panel antibody tests are starting to flood the market with different branding, different providers, and so on. Provider/doctor purchase pricing for these tests have been ranging $4 to $79. It is indeed the Wild West out there right now, and if it sounds too good to be true, it is. Something you pay to import from China may not show up in time or at all. Doctors do not currently have a NO-COPAY CPT code they can bill, which is why this is basically a direct pay business-to-doctor transaction.

Different types of rapid panel antibody tests are being developed. Some tests show that you had the virus, recovered, have a needed antibody level, and should not be able to spread to others. Some tests identify if you are still in the middle of an infection, while other tests use machines to give a near exact timeline for when the virus was contracted based on the body’s antibody response. Regardless of the type of test, rapid panel antibody testing can be a significant cost avoidance approach for health plans that can be strategically implemented with approaches one and two above to significantly reduce the amount that labs and doctors bill to health plans.

There are three basic scenarios with this type of testing:

• An individual has contracted the virus, recovered, and their body has created antibodies. In this scenario, the individual tests positive for antibodies at a level that is presumed that they can return to work and not shed the virus to others.
• An individual has begun to create antibodies, but not at a level that shows recovery from the virus. The CDC recommendation is to conduct swab/PCR testing for secondary confirmation that the individual has the virus and immediately self-quarantine for 14 days.
• An individual shows no creation of antibodies. In this scenario, there are three possibilities.
  1. The individual has not contracted the COVID-19 virus.
  2. The individual has contracted the COVID-19 virus, but they are too early in the development of the virus in their body to show a positive antibody test.
  3. The test failed – test again is recommended.

In these three scenarios, there are no CDC recommendations; however it is recommended if an employer group wants the test run, they should default back to a PCR nasal swab test.

Cost: Assume testing of 10,000 employees. Antibody testing would range from $475,000- $600,000, depending on the practice/doctor purchasing and logistics cost and number of secondary confirmation swabs that would be billed out from lab.

Recommendation: With COVID-19, some current research and data suggests that up to 80 percent of individuals who have contracted the virus are asymptomatic or show very minor symptoms and recover. Rapid panel antibody testing can be used as less expensive first line testing option to determine who these individuals are with the presumption that they can return to work without spreading the virus or contracting it again (reinfection rates are unknown at this time). And you won’t find a doctor on the planet who says you are 100 percent immune once you have had it once; it is all too early to tell.

Summary

There are many testing options, pricing plans, and logistics solutions for employer groups wanting to test employees for coronavirus (COVID-19) when returning to work. With the potential for 50 percent to 90 percent cost savings from overbilling scenarios, the three approaches outlined in this document will help employer groups control their costs as we transition back to work.

While each approach provides benefits, strategies that utilize approach three alone or in concert with other options should be included as a most logical option for any mid-market or large employer that wants to test employees before returning to work.

To execute testing options in a most cost effective and beneficial manner, employers should demand safe, onsite, popup testing clinics. While this can be accomplished in many ways, our company is partial to using the outdoor drive through model, combined with a mobile health care unit. It is recommended that you partner and work with companies with experience handling onsite testing, logistics and large-scale community and private testing.

Editor’s note: Chris Yarn will be conducting a LinkedIn Live with Frank Mengert this Thursday, April 16 at noon Eastern, where they will take questions on the topics covered in this article. 

Chris Yarn is CEO of Walk On Clinic, a logistics, landlord and marketing company that connects primary care doctors to employer groups on site for various services.