CMS to Front Medicare Payments to Physicians for 3 Months

Ken Terry

March 30, 2020

The Centers for Medicare and Medicaid Services (CMS) is expanding a program of accelerated and advance provider payments normally used during natural disasters to supplement the cash flow of Medicare participating healthcare providers and suppliers during the COVID-19 pandemic.

The program expansion was made possible by the recently enacted $2.2 trillion federal rescue package known as the Coronavirus Aid, Relief and Economic Security (CARES) Act.

"With our nation's healthcare providers on the frontlines in the fight against COVID-19, dollars and cents shouldn't be adding to their worries," CMS Administrator Seema Verma said in a news release. "Unfortunately, the major disruptions to the healthcare system caused by COVID-19 are a significant financial burden on providers. Today's action will ensure that they have the resources they need to maintain their all-important focus on patient care during the pandemic."

According to the press release, "Accelerated and advance Medicare payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing…In this situation, CMS is expanding the program for all Medicare providers 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."

Qualifications for Payments

To qualify for accelerated or advance 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 or 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

Medicare will start accepting and processing the accelerated/advance payment requests immediately, CMS said. The agency anticipates that the payments will be issued within 7 days of the provider's request.

Requests must be submitted to the appropriate Medicare Administrative Contractor (MAC). Here is a list of designated MACs.

In a fact sheet on the new accelerated/advance program, CMS said that qualified entities will be asked to request a specific amount of money using a request form available on each MAC's website. Most physician practices will be able to request up to 100% of their Medicare payment amount for a 3-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 6-month period. Critical access hospitals can request up to 125% of their payment amount for a 6-month period.

The accelerated/advance payments will be based on historical amounts paid to each provider or supplier. For 120 days after the issuance of these payments, the entities will continue to submit claims as usual and will receive full payments for their claims during that period.

At the end of the 120-day period, the recoupment process will begin, and every claim submitted by the provider or supplier will be offset from the new claims to repay the accelerated/advance payment. Thus, instead of receiving payment for newly submitted claims, the provider's or supplier's outstanding accelerated/advance payment balance will be reduced automatically by the claim payment amount.

The majority of hospitals will have up to 1 year from the date the accelerated payment was made to repay the balance. After that, the MACs will perform a manual check to determine if there is a balance remaining; if so, the MACs will send a request for repayment of the remaining balance, which will be collected by direct payment. Other providers will have up to 210 days for the reconciliation process to begin.

AMA Praise

The American Medical Association (AMA) praised CMS for expanding the accelerated/advance payment program.

"Practicing medicine is harrowing and dangerous in the face of the pandemic, but less noticed is the fiscal peril that many practices face," AMA President Patrice A. Harris, MD, said in a statement. "The Centers for Medicare & Medicaid Services has recognized this, and its recent action to immediately send accelerated payments to physicians will help keep practices open to Medicare patients. The action is a timely recognition that flexibility is needed at all levels to respond nimbly and effectively to COVID-19."

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