Healthcare providers are receiving about $175 billion from the federal CARES Act and Paycheck Protection Program and Health Care Enhancement Act to support their fight against the COVID-19 pandemic.
CMS: Accelerated Payment Program
On March 28, 2020, the Centers for Medicare and Medicaid Services (CMS) expanded its Accelerated and Advance Payment (AAP) Programs in response to the COVID-19 public health emergency. On April 26, CMS suspended the Advance Payment Program and began reevaluating pending and new applications for the Accelerated Payment Program with additional data on historical direct payments made available from the Department of Health and Human Services (HHS). The American College of Radiology® (ACR®) favors reinstating the Medicare APP.
For the AAP, eligible Medicare providers who have billed claims in the past 180 days, are not in bankruptcy, are not under active medical review and have no outstanding delinquent Medicare payments may request a specific amount of funding from their respective Medicare Administrative Contractor (MAC) websites.
Most practices may request up to 100% of their anticipated Medicare payment amount for a three-month period. Inpatient, children’s and cancer hospitals may request up to 100% for a six-month period. Repayment for accelerated payments must begin no later than 120 days after the date of issuance.
In the recoupment process, every claim submitted will be offset from new claims to repay the accelerated payments. The outstanding accelerated payment balance is reduced by the claim payment amount. This process is automatic.
Most Medicare Part A and Part B providers must pay back the funds in 210 days, with the exception of inpatient acute care, children’s, cancer and critical access hospitals, which will have one year to reimburse the government after the accelerated payments issuance. After 210 days, MACs will send a request for repayment of the remaining balance, which will be collected by direct payment. Furthermore, after 210 days, the outstanding balances of these loans will be subject a 10.25% per annum interest rate.
CMS has posted a fact sheet describing the terms for its accelerated and advance payments for providers and suppliers during the COVID-19 emergency.
HHS: Provider Relief Fund
The HHS Provider Relief Fund allocates funding for providers based on several allocation methodologies. Within the general allocations, the first $30 billion allocated was based on the providers’ share of Medicare fee-for-service reimbursements in 2019. An additional $20 billion in general distributions was allocated to providers proportional to the providers' share of net patient revenue. Providers who have received a payment must use the CARES Provider Relief Fund Payment Portal to sign an attestation confirming receipt of the funds and to agree to the terms and conditions within 45 days of payment (increased from the initial 30-day period).
HHS has used cost report data to allocate funding to providers. Medicare providers who did not provide HHS with adequate cost report data must use the CARES portal to submit their revenue information and to agree to the terms and conditions to receive funds.
Similarly, providers who received funds automatically must submit their revenue information to be verified via the portal. Providers who receive funds from the general distribution must sign an attestation confirming receipt of funds and agree to terms and conditions of payment and confirm the accuracy of the CMS cost report.
Part of the terms and conditions require that providers submit documentation to ensure that HHS funds were used for healthcare-related expenses or constitute lost revenue attributed to COVID-19. HHS has provided a dataset with the list of providers who received a payment from the general distribution of the Provider Relief Fund and who have attested payments and agreed to the terms and conditions.