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CMS approves $34 billion for providers

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In an ongoing effort to provide financial relief for healthcare providers, the Centers for Medicare & Medicaid Services (CMS) has expanded its Accelerated and Advance Payment Program, opening up $34 billion for a broader group of physicians, hospitals, and suppliers. The payment program, expanded in response to the 2019 Novel Coronavirus (COVID-19) pandemic, has been expanded for the duration of the public health emergency.

The new streamlined process has reduced processing times for requests for accelerated or advance payments. The timeframe is expected to be between four and six days during the COVID-19 pandemic, down from the normal timeframe of three to four weeks. CMS has already approved over 17,000 requests.

Accelerated or advance payments are provided during the period of the public health emergency to any Medicare provider or supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and who meets the required clarifications. Part A providers and Part B suppliers, including doctors, non-physician practitioners, and durable medical equipment (DME) suppliers are eligible. CMS has indicated that, while most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.

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To qualify for advance or accelerated payments 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
  • Not have any outstanding delinquent Medicare overpayments.

CMS advance and accelerate payments are not a part of the funding available as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. CARES Act funding of $100 billion does not have to be repaid. The advance and accelerated payments available through CMS are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated and advance payments 120 days after they are disbursed.

CMS clarifies that the provider/supplier can continue to submit claims as usual after the issuance of the accelerated or advance payment; however, recoupment will not begin for 120 days. 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 submitted by the provider will be offset from the new claims to repay the accelerated/advanced payment. Instead of receiving payment for newly submitted claims, the provider’s outstanding accelerated/advance payment balance is reduced by the claim payment amount. The process will be automatic.

The Department of Health and Human Services (HHS) will be providing additional information on how healthcare providers and suppliers can access CARES Act funds in the coming weeks. The CARES Act provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19.