Locke Lord QuickStudy: Medicare Providers and Suppliers to receive Emergency Funding through Expanded CMS Accelerated and Advance Payment Program

On Saturday, March 28th, the Centers for Medicare & Medicaid Services (“CMS”) announced an expansion of its accelerated and advance payment program for Medicare participating health care providers and suppliers to help provide the resources needed to combat the 2019 Novel Coronavirus (“COVID-19”). This program expansion resulted from changes from the recently enacted Coronavirus Aid, Relief, and Economic Security (“CARES”) Act.

Accelerated and advance Medicare payments provide emergency funding and addresses cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, CMS is expanding the program for all Medicare providers and suppliers throughout the country during the public health emergency related to COVID-19.  The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers.

CMS outlined the accelerated/advance payment process and how to submit a request in its Fact Sheet released over the weekend:

Eligibility:

To qualify for accelerated or advance payments, the Medicare 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, and
• not have any outstanding delinquent Medicare overpayments.

Amount of Payment:

Qualified providers and suppliers will be asked to request a specific amount using an Accelerated or Advance Payment Request form provided on each Medicare Administrative Contractor (“MAC) website. 

• Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period.
• Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals can 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.

Processing Time:

MACs will start accepting and processing the Accelerated/Advance Payment Requests immediately. Providers / suppliers should contact their MACs to request an Accelerated / Advance Payment Request form.  If the request is approved, CMS anticipates that the payments will be issued within seven (7) days of the provider’s / supplier’s request.   

Repayment & Reconciliation:

The provider / supplier can continue to submit claims as usual after the issuance of the accelerated or advance payment; however, recoupment of the accelerated or advance payment will not begin for 120 days.  Providers / suppliers will receive full payments for their claims during the 120-day delay period.  After the 120-day period, the recoupment process will begin and every claim submitted by the provider / supplier will be offset to repay the accelerated / advanced claim, and the provider’s / supplier’s outstanding accelerated / advance payment balance will be reduced by the payment amount.  This will be an automatic process.

Inpatient acute care hospitals, children’s  hospitals, certain cancer hospitals, and CAH will have up to one (1) year from the date the accelerated payment was made to repay the full balance.  This means that after the one year expires, if a hospital still has a balance, the MAC will send a request for repayment of the remaining balance.  All other Part A providers and Part B suppliers will have 210 days from the date the accelerated or advance payment was made to repay the balance.  If a Part A provider receives Period Interim Payment (“PIP”), the accelerated payment reconciliation process will happen at the final cost report process (180 days after the fiscal year closes).

Your Locke Lord contacts and the authors of this article would be happy to assist with any follow up questions regarding application for accelerated / advance Medicare payments.

Please visit our COVID-19 Resource Center often for up-to-date information to help you stay ‎informed of the legal issues related to COVID-19.‎