Many providers received their first payments from the CARES Provider Relief Fund on April 10 to help cover the costs of preparing for, testing, and treating COVID-19 patients as well as to offset health care related expenses or lost revenues that are attributable to the coronavirus.
Providers receiving funds have 30 days to sign an attestation via the CARES Act Provider Relief Fund Payment Attestation Portal confirming receipt of the funds and agreeing to the terms and conditions of payment. If they choose not to accept the money, providers have 30 days to return it. Not returning it in 30 days is the same as accepting it, according to documentation emailed to providers, and in that case, the terms and conditions still apply even without consent.
Check the Fine Print
There may be a problem for some providers, however, and it’s buried in the fine print of the terms and conditions: Providers who keep the money are agreeing not to balance bill COVID-19 patients for treatment. And according to guidance elsewhere on the Provider Relief Fund webpage, “HHS broadly views every patient as a possible case of COVID-19.”
When asked for clarification about the policy, a spokesperson for the Department of Health and Human Services (HHS) said last Friday, “The intent of the terms and conditions was to bar balance billing for actual or presumptive COVID-19. We are clarifying this in the terms and conditions.”
The current terms and conditions document includes the following statement:
“The Secretary has concluded that the COVID-19 public health emergency has caused many healthcare providers to have capacity constraints. As a result, patients that would ordinarily be able to choose to receive all care from in-network healthcare providers may no longer be able to receive such care in-network. Accordingly, for all care for a presumptive or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in network Recipient.”
The issue of out-of-network balance billing, or surprise billing, has been hotly debated for years, ramping up last year with several proposed bills in both the House and Senate to address it. However, even with both bipartisan and public support, not to mention a green light from the White House, no federal legislation has been passed. Instead, HHS seems to have accomplished the feat in a single paragraph.
But many industry experts don’t believe the issue is so cut and dried.
“Because the terms and conditions do not appear to be sufficiently clarified, there is a concern that there will be legal challenges around the balance-billing provision,” said Rodney Whitlock, a health policy consultant and former Senate staffer, in an interview with Kaiser Health News.
As well, until there is greater clarification, the issue may keep some patients from seeking treatment, according to Jack Hoadley, a professor emeritus of health policy at Georgetown University and former commissioner of the Medicare Payment Advisory Commission.
“The providers, the insurers, everybody else is going to need clarification, as well as, of course, all of us as potential patients,” Hoadley said. “That’s going to affect our willingness to” seek testing or treatment, he said.
More Money to Come
Meanwhile, HHS announced this week how they plant to distribute the rest of the $100 billion CARES Provider Relief Fund money. According to a April 22, 2020, Fierce Healthcare article, the breakdown is as follows:
- $20 billion to providers based on net patient revenues from 2018 from all sources;
- $10 billion to hospitals in areas hit hard by the COVID-19 outbreak;
- $10 billion to rural hospitals; and
- $400 million to Indian Health Service facilities.
HHS Secretary Alex Azar said that any remaining money will go to skilled nursing facilities, providers who treat primarily Medicaid patients, second-wave COVID-19 hotspots, and uninsured claims.
For more information about the provider relief money and how to accept or return any funds distributed to you or your practice, visit the CARES Act Provider Relief Fund webpage.
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