COVID office testing

As we gear up for winter, wanted to get ideas from other practices on their plans for flu and COVID testing. It is that time when we look for good deals on flu test kits. My gut is that we may only need half the number from last year. Let year was our busiest flu season in ten years and then it came to an abrupt stop when quarantine kicked in and social distancing started.

I realize this will be regional dependent. Some areas have easy access to COVID testing outside of the private practice, however some have to do it in house if they want access to it. Some turn around for results is same day and in some areas it is 5-7 days.

Unfortunately to my knowledge, the quick antigen test are not where we had hoped they would be by now. Which leaves us with molecular PCR testing as the best option.

Our regional children’s hospital is making plans to have capacity to do flu and COVID test at the same time, which is great.

We are looking at the ABBOTT ID now system. I go back and forth on whether we pursue it. In our region the flu and strep testing with the system had many problems with reimbursement, barely breakeven or for some a loss.

I know our nursing staff is not excited at all with having in house testing ability for COVID, but it would be great for our patients.

So bottom line was looking for feedback from folks that have been doing molecular testing in house or plan to do this winter, also looking for feedback on thoughts for ordering flu kits and what folks expectations are for this winter and ill visits.

Crystal ball please and thank you.

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I’m seeing many proactive seriously consider the Abbott ID now system for COVID and transition flu/strep/RSV.

As for number of flu tests, some are speculating that while children are less likely to get flu this year thanks to strong interest in flu vaccines and social distancing, many still wonder if the flu test if going to be part of the differential when a sick child lands in your office. If so, the number of flu tests could readily repeat last year for many.

All this to say that the crystal ball can’t seem to find a read. But I hope my thoughts help you in some way.

We are gearing up for the season. We did get Abbott ID now. We use this for flu and now have ordered Covid testing as well. We will likely have a dedicated suite for febrile patients and testing.

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During the flu season we are planning to test for both flu and covid since there is not really any way clinically to tell them apart other than their exposure history (which potentially could have been exposed to either). This past year we had switched to Abbott molecular flu and molecular rsv since they were more accurate AND they reimbursed better than our previous antigen tests (both for Medicaid and private payors) . we could feel better about our negative results compared to the tests we had used in previous years since they were much more sensitive. Our nurses really liked the testing materials and the machines. Since we were already using those Abbott tests we already have the machines and they are just coming to add some extra software so that we can run the in house covid molecular testing. They give you the number of machines based on the number of tests you order and expect to run (never had to buy any equipment). We have been told we should be getting the testing materials by next month. I have not seen the reimbursement yet for the covid molecular testing so not sure how that will match to the flu and rsv payments but we are willing to run those even with minimal profit since all of the urgent cares around here are already doing rapid testing and we have to keep our patients coming here and not going there . The allotment we have for the covid testing was based on the number of flu tests we ran last year and we are ordering the same number of flu this year. We have had no problems with the service /customer reps with our abbott testing in the past so hopefully that continues on this season.

D Brown

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D Brown
That is great information and thanks for your reply. This is definitely some of the key info. Break even at least and keep patients coming to our practice vs urgent care.
Fully understand the test is not perfect, but better than simple antigen test.
Key hurdle in our office will be comfort level of those performing the swab and PPE utilization required.
We have been stock piling PPE and suggesting COVID testing is coming soon to our office for the past 3 months for our staff.
Buying the Abbott ID now feels like buying a time share right now. Limited time only, we can get you the system in a few weeks, but can’t guarantee it will be available a month from now. Should pay for itself, but no guarantee we won’t increase the cost of test kits (annual maintenance fees) due to demand that is below reimbursement (Anthem).
Academically less sensitivity and specificity than our local children’s hospital and greater risk for our staff. But quicker turn around, keeps patients coming to us, and greater convenience for our patients.

I feel bipolar on the decision, and likely to say go for it and justify it with CARES act funding and make sure providers are comfortable doing the test themselves, fingers crossed MA/RN will follow with comfort. We are going to need to do flu/strep test anyway. Might as well get comfortable and perfect infection control.

Again thanks for input and appreciate everyone else’s thoughts and plans on this, and I reserve the right to change my opinion every 2hrs like the schools are doing.
Bill

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I am also interested in what others will be doing. I am in a smaller town in East Texas and there is no where to get tested here. I have also had the ID Now molecular product in office for 2 years and am awaiting this week our first 5 boxes of COVID-19 test. We billed for 1601 Flu test last season. We have 2 Pediatricians and one Nurse Practitioner. I expect we will test for at least 1200 this season. We are trying to come up with our phone and office protocol for COVID-19 testing. The physicians say that we do not want to test in the office for any reason while starting out. We believe we will designate an hour window in the AM to do drive up testing. We will designate 3 spots in our parking lot (kinda like Walmart grocery pickup) call the office when you get here and we will do all the check in process on the phone. One nurse will be designated to work the curbside testing. They will go and take temperature and swab and we will send them away at that time.When we have results later that day we will call them to give results. If Positive then telemedicince visit will be conducted. If Negative they will then be given an option to have a face to face or do a telemedicine visit at that time. Still working out all the kinks and have not started it yet but would love some feedback from others on the their process.

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Wow! I am wondering if you work in my office and just don’t know it!!! We are literally in the same boat right now. We are back and forth about the Abbott ID Now because the test kits are SO much more expensive than the antigen tests we currently use for strep and flu.

I looked at the reimbursements and our biggest payor (Independence Blue Cross - Phila area insurance) is not covering the cost of the COVID testing through Abbott, and due to insurance contracting regulations you cannot charge a patient for a service that is considered “covered” by the insurance, even if you lose money on it.

The biggest issue seems to be United Healthcare. When I ran the fee schedule numbers for all 3 Abbott tests (flu, strep, COVID), they pay below the cost for each of those tests.

We plan on using our HHS Cares Grant money for some of this and I guess we’ll see going forward how much we do/don’t like it. It’s just that $1,100 for one flu (24) kit is hard to swallow when you’re used to paying $220 for the antigen kit! We do plan on ordering the same amount of kits as we did last year for flu. They usually have a pretty long expiration date so if we don’t use them, there’s a good chance they’ll still be good through the next season.

Btw, I laughed out loud at your comment about reserving the right to change your mind every 2 hours like the schools. Thanks for the laugh today!

We are doing antigen testing via Quidel’s Sofia. We found this coding/billing guide to be extremely helpful:

Note specifically the following outlined in the guide: CMS has approved 99211 for specimen collection for new and established patients with 4/30 IFR; check other payers for reimbursement policies.

This helps make up any loss, although we’ve found the major payers are covering. We’ve billed COVID plus the 99211 (and CS modifier on each charge), unless there was an actual office visit, and have not experienced any issues to-date.

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Update on our COVID test. First, the test were supposed to come in 1st week of August. on Friday before they were supposed to come they said oh sorry delayed a week. Then on Monday this week they said oh sorry we won’t have any till probably September. Crazy times we are living in. Thinking on using the antibodies test we were able to acquire early on and just not charge for them.

Are you getting paid for 87426, the CPT for Antigen tests? CMS has yet to announce the payment.

Our practice was told by our McKesson rep that we would need to sign a 12 month contract if we wanted to run covid POC in our office using our Abbott machines. Specifically, the contract would require that we order a minimum number of test kits every week for the duration of the contract. Given the cost of each test (~$42) and the fact that 2 controls must be run per new batch of kits, we are hesitant to take the financial risk. Have other practices encountered this type of arrangement with their lab supplier?

I’m hearing some practices consider the Covid testing as a loss leader among Flue/Strep/RSV run on the Abbott system. When looking at the collection of these four tests on the Abbott, a practice may still make money even though the Covid testing loses money each time. I’m not 100% convinced this is the right approach but does provide some opportunities to gain a competitive advantage over your competitors. In some situations, people are making money on Medicaid testing. One approach is to provide Covid for only the payors that cover the cost and then flex up as payers increase their payments.

Under this approach, the flu/strep volume would be enough for a few machines while allowing a minimal Covid test kit order…

Paulie, can you please expand on “Medicaid Testing” and “flex up as payers increase their payments”. I have ID NOW and do all their tests.

In some situations, Medicaid payment covers the supply cost while private payors are not covering supply cost. So, offer COVID testing in house for those payors that are covering costs and add more as more payors agree to pay a respectable rate (covering supply costs).

Thanks. We have tested a few private patients to test their payments.

FDA just gave EUA to Abbott for a $5, 15 minutes COVID antigen test. It also has a phone app which sends out results. I have contracts for Abbott, Sofia tests and have the machines and do all the tests. For those who don’t have the tests and have the contracts, consider cancelling the contracts. I am going to renegotiate.

Test results are very impressive, from the FDA https://www.fda.gov/media/141570/download

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The Federal Gov. is buying up all the 150 million tests.

Yeah, I’m pretty sure after the nursing homes, urgent cares and the government, there won’t be much left for us little guys.

We were in the process of ordering Abbott ID Now machines, 900 test commitment per machine at $40+ per test when news broke that Abbott just got approval for a $5 dollar BinaxNOW card test without a machine. Our rep today says that is just for schools, government and retail, NOT medical offices. Are others hearing this or is it just our rep not wanting to lose commissions? Abbott not wanting to lose the money invested in machines?

Thomas Seitz, MD
Island Coast Pediatrics

The federal government bought all Binax tests upto year end. No one really knows where these tests are going. As per the EUA, one must have a CLIA ID to do the tests.
Don’t go for ID NOW COVID 19 test.You will lose $ once you account for taxes, shipping, controls plus the inevitable “Invalid” tests. The flu and strep are good for us. Cancel the COVID requirement. Try to get Sofia tests. The BD Veritor make less sense. The latter 2 tests have their own availability issues. I am sure they will also come out with their version of cheap tests.The Economics 101 is on.