The Centers for Medicare and Medicaid Services (CMS) issued guidance on March 28, 2020, outlining how Medicare providers and suppliers can access accelerated and advanced Medicare payments to address financial burdens during the coronavirus (COVID-19) public health emergency. The guidance implements a provision in the CARES Act, the third stimulus bill recently enacted by Congress (see Baker Donelson summary of health care provisions in the CARES Act here).
The CARES Act expanded the Accelerated and Advanced Payment Program, an existing Medicare program that allows providers and suppliers to access accelerated or advance Medicare payments to address cash flow issues during disruptions in claims submissions and/or claims processing. The expansion makes the program available to all Medicare providers during the COVID-19 public health emergency, allowing all Part A providers and Part B suppliers to be eligible.
Below is a summary of the CMS guidance and how providers/suppliers can apply for accelerated payments.
Eligibility
During the COVID-19 public health emergency, accelerated payments are available to all Medicare Part A providers and Part B suppliers. Medicare will allow additional hospital types that are not eligible for accelerated payments under the existing program to access the payments. The added hospital types include children's hospitals, certain cancer hospitals, and critical access hospitals (CAHs).
To qualify for expedited payments, providers/suppliers 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.
Significant questions remain about eligibility for the accelerated payments for those providers undergoing medical review audits or investigations. Providers who are considered (or suspected) to be in arrears with the Medicare program would not be permitted to access the advanced payments. Outstanding questions include:
- Would a provider undergoing a Targeted Probe and Educate (TPE) program review be "under active medical review"?
- Would a supplier under Zone Program Integrity Contractor (ZPIC) audit be considered under a "program integrity investigation"?
- Would a provider appealing a post-payment denial be considered "under active medical review"?
Accelerated Payment Amount
Most providers and suppliers will be able to request up to 100 percent of the 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. CAHs can request up to 125 percent of their payment amount for a six-month period.
What is not entirely clear at this point is exactly how much providers/suppliers will be entitled to under the program. The CMS press release says the payments will be based on "historical payments." A Senate summary (see Section 3719) of the provision in the CARES Act says the payments "would be based on net reimbursement represented by unbilled discharges or unpaid bills." The request form from one of the hospital Medicare Administrative Contractors (MACs) asks for (a) general cash fund position for provider as of a date presumably chosen by the provider, (b) anticipated receipts from all sources (exclusive of accelerated payments) in the next 30 days, (c) anticipated expenditures in next 30 days, and (d) indicated cash position in next 30 days. The request form from one of the DME MACs has more open-ended questions about explaining the need for payments.
Claims Filing and Recoupment Processes
Providers/suppliers can continue to submit claims as usual after the issuance of accelerated payments, and providers/suppliers will receive full payments for 120 days before a recoupment process begins. After 120 days, payment for claims will be offset to repay the accelerated payments. Thus, instead of receiving reimbursement for newly submitted claims, the reimbursement will go towards repaying the accelerated payments.
The repayment timeline depends on the provider/supplier type:
- Inpatient acute care hospitals, children's hospitals, certain cancer hospitals, and CAHs have up to one year from the date the accelerated payment was made to repay the balance.
- All other Part A providers and Part B suppliers will have 210 days from the date the accelerated payment was made to repay the balance.
- For Part A providers who receive Period Interim Payment (PIP), the accelerated payment reconciliation process will happen at the final cost report process (180 days after the fiscal year closes).
Application Process
Providers/suppliers must complete an Accelerated or Advance Payment Request form issued by their MAC that will ask the provider/supplier to request a specific payment amount. Request forms will vary by MAC, and providers/suppliers can find the request forms on a MAC's website. If the request is approved, providers/suppliers should receive payments within seven calendar days of the request.
Each MAC is operating a COVID-19 hotline to assist with accelerated payment requests. Information to help locate the MAC for a provider/supplier's geographic area can be found here.
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Baker Donelson will continue to monitor CMS guidance and provide updates regarding the Medicare Accelerated and Advanced Payment Program.
