Even while hospitals and clinics across the country are filling up with patients testing positive for COVID-19, social distancing guidelines and efforts to preserve personal protective equipment mean many physicians are canceling elective procedures and seeing fewer patients, which in turn has a negative effect on the bottom line of many practices.
To help providers maintain cash flow during this critical time, the Centers for Medicare & Medicaid Services (CMS) is expanding its accelerated and advance payment program for Medicare participating health care providers and suppliers through the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
How It Works
According to CMS, accelerated and advance Medicare payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. The expedited payments typically are offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.
Payments can be requested by hospitals, doctors, durable medical equipment suppliers, and other Medicare Part A and Part B providers and suppliers. To qualify, the provider or supplier must:
- Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form,
- Not be in bankruptcy,
- Not be under active medical review or program integrity investigation, and
- Not have any outstanding delinquent Medicare overpayments.
Most providers and suppliers can request up to 100 percent of their Medicare payment amount for a three-month period. Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100 percent of the Medicare payment amount for a six-month period. Critical access hospitals (CAH) can request up to 125 percent of their payment amount for a six-month period.
Providers can continue to submit claims as usual after the issuance of the accelerated or advance payment, and repayment will begin 120 days later through recoupment. Providers will receive full payments for their claims during the 120-day delay period. At the end of the 120-day period, the recoupment process will begin, and every claim unpaid at that time or submitted afterwards will be used to repay the accelerated/advanced payment.
A reconciliation process will begin for payments not repaid within one year by most hospitals and within 210 days by most other providers. Any amount outstanding must then be paid in full by the provider.
Applications for accelerated and advance Medicare payments differ for each Medicare Administrative Contractor. The application for WPS-GHA, Indiana’s Part A and B MAC is available on the home page of their website. To find applications for other MACs, review this list of MACs and their websites. Each MAC will work to review and issue payments within seven calendar days of receiving the request.
Before applying for the accelerated and advance Medicare payments, providers should consider whether it is in the best interest of their practice to receive advance money now, which will cause a temporary decline in Medicare after 120 days. As well, providers do not need to request the full 100 percent of the available money if it’s not currently needed. Finally, physicians or other individual clinicians who are members of group practices should consult with their group’s administrators or other leaders to determine policies for receiving accelerated and advance Medicare payments.
Authorized representatives are allowed to request accelerated and advance Medicare payments on behalf of providers and suppliers. CIPROMS recommends that clients and other providers designate an office manager, administrator, or accountant to handle these requests. As a billing company, CIPROMS does not submit accelerated and advance Medicare payment requests as part of our services.
For more information, review the CMS Fact Sheet: Expansion of the Accelerated and Advance Payments Program for Providers and Suppliers during COVID-19 Emergency.
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