Centers for Medicare & Medicaid Services (CMS) Provides Cash Flow Relief for Medicare Part A Providers and Part B Suppliers
CMS expanded its current Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers impacted by the COVID-19 pandemic. The program expansion includes changes from the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
The program advances future Medicare payments to providers/suppliers. In order to qualify for the program, providers/suppliers must meet the following requirements:
- 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
To receive an accelerated/advanced payment, providers/suppliers must complete an Accelerated/Advance Payment Request Form. This form along with other Medicare Administrative Contractors (MAC) forms can be found on each provider’s/supplier’s individual MAC website.
Below are sample documents from Noridian Healthcare Solutions Jurisdiction E:
On the accelerated/advance payment request form, qualified providers/suppliers must request a specific dollar amount from its Medicare Administrative Contractor (MAC). The maximum amount providers/suppliers can request is as follows:
- Inpatient Acute Care Hospitals, Children’s Hospitals, and certain other Cancer Hospitals
- Up to 100% of the Medicare payment amount for a six-month period
- Critical Access Hospitals (CAH)
- Up to 125% of the Medicare payment amount for a six-month period
- Most other provider’s/supplier’s
- Up to 100% of the Medicare payment amount for a three-month period
Upon receiving the accelerated/advance payment request form(s), the MAC will validate the provider/supplier meets qualification criteria. After validation, the MAC will notify the provider/supplier if the request is approved or denied. If the request is approved, the payment will be issued within seven calendar days from the request submission date.
As this is an advancement of future Medicare payments, the reimbursement to Medicare will be via recoupment. Providers/suppliers will continue to submit claims as usual to Medicare after it has received the accelerated/advance payment. Medicare will continue to pay the claims to the provider/supplier for the first 119 days after accelerated/advance payment is received. On day 120, Medicare begins the recoupment process. Instead of receiving payment on newly processed claims Medicare will apply the payment to the accelerated/advance amount until it is paid in full.
- Most inpatient acute care hospitals, children’s hospitals, certain cancer hospitals and CAH’s will have up to one year from the date the accelerated payment was made to repay the loan. If a balance remains, the MAC will send a request for repayment of the remaining balance.
- All other part A providers and Part B suppliers will have up to 210 days for the reconciliation process to begin.
- For Part A providers receiving Period Interim Payments (PIP) repayment and reconciliation process will be at the time of the final cost report.
This is a large movement to help ease the financial burden on the front lines and ensure the financial resources needed for the best patient outcomes are being delivered without major delays.
Uprise Consulting Group, Inc. is helping Hospital Providers, including Critical Access Hospitals (CAH), navigate the application process with their corresponding Medicare Administrative Contractors (MAC). Uprise includes Covid-19 charge capture changes, elimination of preventable denials services and up-to-date resources for CMS changes. Feel free to reach out to Uprise Consulting Group, Inc.’s experienced team at www.UpriseCG.com for any resource, billing or denials needs.
Access to the CMS press release and Accelerated and Advance Payments facts sheet and other documents can be found here: