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HHS Care Act additional allocations

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The COVID-19 pandemic has affected healthcare providers in many ways. Some physicians are stressed with how to continue providing quality care to their patients. Healthcare delivery has shifted to telehealth in many locations. Independent physicians are feeling the financial strain of the outbreak. To help alleviate some of the distress placed on providers by the coronavirus outbreak, relief funds have been appropriated to hospitals and other healthcare providers under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

The CARES Act was initially signed into law on March 27, 2020 and included $100 billion for the Provider Relief Fund. The first round of funding, $30 billion, was distributed in early and mid-April and was “proportionate to providers’ share of Medicare fee-for-service reimbursements in 2019,” according to the US Department of Health & Human Services (HHS).

HHS has announced that it “has begun distributing the remaining $20 billion of the $50 billion general distribution to Medicare providers to augment providers’ allocations so that the whole $50 billion general distribution is allocated proportional to providers’ share of 2018 net patient revenue.”

On April 24, a portion of providers were automatically sent an advance payment based off the revenue data they submitted in CMS cost reports. Providers without adequate cost report data on file will need to submit their revenue information to the General Distribution Portal for additional general distribution funds.

In addition, the COVID-19 Uninsured Program Portal, which allows healthcare providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020 to request claims reimbursement, is now live. HHS has clarified that it “broadly views every patient as a possible case of COVID-19.” The organization has also stated that “a healthcare provider’s eligibility is not adversely affected if it ceased operations as a result of the COVID-19 pandemic, so long as the healthcare provider provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19.”

The terms and conditions of receiving the relief funds include:

  • All recipients will be required to submit documents sufficient to ensure that these funds were used for healthcare-related expenses or lost revenue attributable to coronavirus.
  • Providers must agree not to seek collection of out-of-pocket payments from a presumptive or actual COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.

Independent practices are being significantly impacted by the coronavirus. The Medical Group Management Association (MGMA) conducted a survey in early April and received 724 applicable responses, approximately 75% of which were part of independent medical practices and employed less than 50 full-time-equivalent (FTE) physicians.

The survey revealed that 97% of those practices have experienced a negative financial impact directly or indirectly related to COVID-19. The survey also found that, on average, practices have experienced a 55% decrease in revenue and 60% decrease in patient volume since the beginning of the COVID-19 crisis.

Elation Health is dedicated to supporting independent physicians throughout the coronavirus outbreak. We have developed a COVID-19 Resource Center that includes information on Financial Resources for your practice, as we are committed to ensuring your success in dealing with the economic effects of COVID-19.