Healthcare providers around the country will start to receive more of the CARES Act Provider Relief Fund in the coming days. The remaining $20 billion of the $50 billion general distribution is being allocated based on annual revenues and estimated COVID-related losses. Additionally, healthcare providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement.
Round Two of the General Distribution
In late March, Congress earmarked $100 billion as part of the CARES Act to provide relief to hospitals and other healthcare providers on the front lines of the coronavirus response. Half of that money was earmarked for general distribution, and to be eligible for the general distribution, a provider must have billed Medicare in 2019 and provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 after January 31, 2020. HHS went on to say that it broadly views every patient as a possible case of COVID-19.
From April 10 through 17, the Department of Health and Human Services (HHS) distributed the first $30 billion of the $50 billion general distribution to healthcare providers in proportion to their Medicare Fee for Service payments in 2019. Now, HHS has begun distributing the remaining $20 billion of the general distribution to Medicare providers based on revenue information provided to HHS through the General Distribution Portal.
To be eligible for a portion of the remaining $20 billion, providers must meet the following additional criteria:
- They must have already received a Provider Relief Fund Payment by 5:00 pm EST, Friday April 24th.
- They must attest to having received the payment via the Provider Attestation Portal, and agree to the Terms and Conditions on the attestation portal.
Providers will need to provide the following in order to apply for this second round of General Distribution money:
- Group NPI
- Medicare #
- Rendering site location
- Payment address
- a provider’s “Gross Receipts or Sales” or “Program Service Revenue” as submitted on its federal income tax return;
- the provider’s estimated revenue losses in March 2020 and April 2020 due to COVID;
- a copy of the provider’s most recently filed federal income tax return;
- a listing of the TINs any of the provider’s subsidiary organizations that have received relief funds but that DO NOT file separate tax returns.
Some providers for whom Medicare has adequate cost report data on file may have already received additional funds; however, those providers will still need to submit the required revenue information via the General Distribution Portal so that it can be verified.
For more information, HHS has created an FAQ document about the General Distribution Funds and Portal. Also, step-by-step instructions for accessing General Distribution Portal and completing the application have been made available.
Funding for Uninsured COVID-19 Testing and Treatment
In early April, HHS announced that a portion of the $100 billion Provider Relief Fund would also be used to reimburse healthcare providers for COVID-related treatment of uninsured patients going back to February 4, 2020. As well, $1 billion from the Families First Coronavirus Response Act (FFCRA) also is being used to reimburse providers for conducting COVID-19 testing for the uninsured.
To access these funds, providers must enroll on the COVID-19 Uninsured Program Portal, which opened April 27. They must also agree to the following during registration:
- They have checked for health care coverage eligibility and confirmed that the patient is uninsured. They have verified that the patient does not have coverage such as individual, employer-sponsored, Medicare or Medicaid coverage, and no other payer will reimburse them for COVID-19 testing and/or care for that patient
- They will accept defined program reimbursement as payment in full.
- They agree not to balance bill the patient.
- They agree to program terms and conditions and may be subject to post-reimbursement audit review.
The Human Resources & Services Administration (HRSA) of HHS and UnitedHealth Group, the administrative contractor, will provide technical assistance to enrolled providers beginning on April 29. Claims can be submitted beginning May 6, and providers can expect to begin receiving reimbursements by mid-May. Claims will be reimbursed at Medicare rates, subject to available funding.
Testing for COVID-19 and treatment services with a primary COVID-19 diagnosis will be reimbursed under this program, including the following:
- Specimen collection, diagnostic and antibody testing.
- Testing-related visits including in the following settings: office, urgent care or emergency room or via telehealth.
- Treatment, including office visit (including via telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), acute inpatient rehab, home health, DME (e.g., oxygen, ventilator), emergency ground ambulance transportation, non-emergent patient transfers via ground ambulance, and FDA approved drugs as they become available for COVID-19 treatment and administered as part of an inpatient stay.
- FDA-approved vaccine, when available.
- For inpatient claims, date of admittance must be on or after February 4, 2020.
Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded:
- Any treatment without a COVID-19 primary diagnosis, except for pregnancy when the COVID-19 code may be listed as secondary.
- Hospice services.
- Outpatient prescription drugs.
For more information about COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured, check out these resources:
- The COVID-19 Uninsured Program Portal
- HRSA COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured Webpage
More Money Coming?
On April 24, 2020, President Donald Trump signed the Paycheck Protection Program and Health Care Enhancement Act into law, allocating another $484 billion in relief during the COVID-19 public health emergency. Hospitals are expected to receive another $75 billion of that money to cover the cost of diagnosing, testing, and caring for COVID-19 patients.
The bill also includes another “$25 billion for expanding and administering COVID-19 testing for active infection and prior exposure as well as conducting surveillance and contact tracing,” explains Shannon Muchmore, in a recent Healthcare Dive article, “Trump signs bill designating additional $75B for hospital COVID-19 response.”
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