By Jed Morrison
The Centers for Medicare & Medicaid Services (CMS) has expanded its accelerated and advance payment program to provide immediate interest-free cash support to Medicare providers during the COVID-19 public health emergency.
The existing Medicare Accelerated and Advance Payments Program provides emergency funding to address cash flow issues for providers (based on their historical payments), when there is a disruption in claims submission or processing. The payments are typically offered in areas where natural disasters such as hurricanes and floods have occurred. During the COVID-19 public health emergency, CMS is expanding the program to all Medicare providers and suppliers throughout the country. CMS is now authorized to provide accelerated or advance payments during the period of the public health emergency to any Medicare provider/supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the required qualifications. The payments can be requested by hospitals, physicians, durable medical equipment suppliers, and other Medicare Part A and Part B providers and companies.
To qualify for advance payments the provider or supplier must:
- Have billed Medicare for claims within 180 days of application;
- 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 such as physician groups will be able to request up to 100% of their Medicare payment amount for a CMS determined three-month period.
- Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100% of the Medicare payment amount for a six-month period.
- Critical access hospitals (CAH) can request up to 125% of their payment amount for a six-month period.
- Example: Hospital averages $5 million per month in Medicare payments. Hospital can request and receive $30 million.
- Providers will continue to submit and be paid for Medicare claims as usual; no recoupment of the advance amounts will begin until 120 days after payment. At the end of the 120-day period, the amount due for every new claim submitted by the provider automatically will be offset against the advance payment amount.
- Medical groups and other Part B suppliers must complete the repayment no later than 210 days after payment.
- Most hospitals will have up to one (1) year to complete the repayment process.
Providers submit a simple one-page Novitas Solutions request form, which will be evaluated and payment made by the MAC within seven (7) days.
The advantage of the advance payments program is immediacy: providers can receive interest-free payments in as little as seven days. When combined with the small business loan programs also contained in the CARES Act, some qualifying providers could receive immediate cash, repaying it with loaned funds which later would be forgiven.
Edgar “Jed” C. Morrison, Jr. has practiced healthcare law for almost 40 years and is one of the founding members of Jackson Walker’s Healthcare section. With a board certification in Health Law by the Texas Board of Legal Specialization, Jed exclusively represents healthcare providers and other industry participants related to the regulatory and transactional aspects of healthcare law. In recognition of his practice, Jed has been named among Chambers USA for Healthcare in Texas since 2006, among The Best Lawyers in America for Healthcare Law since 2007, as a “Super Lawyer” by Thomson Reuters (2007-2016, 2018-2019), and as a “Best S.A. Lawyer” in the Healthcare area by San Antonio Scene since 2010.
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