CMS Expands Groups Eligible for Accelerated Medicare Payments Program During COVID-19 Emergency

On the day following the enactment of the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), the Centers for Medicare & Medicaid Services (CMS) made clear its intention to expand the groups of medical providers and enterprises that can benefit from accelerated and advance Medicare payments (originally available only for certain hospitals). This expansion is consistent with, and in addition to, measures included in the recently enacted CARES Act.

Per CMS' March 28, 2020, press release:

Accelerated and advance Medicare payments provide emergency funding and address cash flow issues based on historical payments when there is a 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 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 also provided a Fact Sheet detailing what providers and suppliers must know about the expansion of the accelerated/advance payments program, including:

• eligibility and process, including the payment amounts and processing times
• recoupment and reconciliation considerations
• a step-by-step guide on how to request accelerated/advance payment, including the necessary request form, what to include, who must sign, how to submit, the role of the Medicare Administrative Contractor (MAC), timing on payments and repayments, and appeals rights

Providers must carefully review the CMS Fact Sheet to understand the necessary steps to request accelerated/advance payments and the rules regarding the recoupment and reconciliation process. The following CMS guidance is also particularly important to highlight.

Eligibility

• With respect to being eligible for accelerated/advance payments, the provider/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. Additionally, to qualify, an applicant must not be in bankruptcy, not be under active medical review or program integrity investigation, and not have outstanding delinquent Medicare overpayments.
• Although the CMS Fact Sheet does not explicitly name Part B providers, it appears that the intent of the March 28, 2020 press release was to include an expansive constituency of healthcare professionals consisting of "hospitals, doctors, durable medical equipment suppliers, and other Medicare Part A and Part B providers and suppliers." Thus, while it appears that Part B providers are included (per the press release), this point of ambiguity should be clarified with each provider's MAC, where applicable.

Recoupment and Reconciliation

• Providers and suppliers must understand that accelerated/advance payments will be recouped by CMS. The recoupment process will begin 120 days after the date of the issuance of the payment. The purpose of the advance payments is to help sustain a stable cash flow to, in turn, maintain the necessary workforce, purchase supplies and equipment, and treat patients during this pandemic.
• Notably, providers and suppliers 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/supplier will be offset from the new claims to repay the accelerated/advanced payment. Thus, instead of receiving payment for newly submitted claims, the provider's/supplier's outstanding accelerated/advance payment balance is reduced by the claim payment amount. This process is automatic.
• Acute care hospitals, Critical Access Hospitals (CAHs), children's hospitals and cancer hospitals have one year after the accelerated payment issuance before payment is required in full. All other Part A providers and Part B suppliers (and presumably Part B providers) will have 210 days from the first accelerated payment date to repay their balance.
• At the end of the repayment period (210 days for certain providers/suppliers, one year for most hospitals), the MAC will determine if the provider/supplier has a remaining balance and send a request for repayment, if necessary. For Part A providers that receive periodic interim payments, the reconciliation process will happen at the final cost report process (180 days after the fiscal year closes).

How to Request an Accelerated/Advance Payment and Amount of Payment

• To request an accelerated/advance payment, a qualified Medicare Part A or Part B provider or supplier must submit the proper accelerated/advance payment request form to its servicing MAC via mail, fax, or email (though CMS stated that electronic submission would substantially reduce processing time).
• Please note that accelerated/advance payment request forms vary by each MAC (and accordingly, can be found on each individual MAC's website). CMS directs providers to this link to help them identify their appropriate MAC.
• Once providers identify their MAC, the provider must request a specific amount to be paid using an accelerated/advance payment request form provided on each MAC's website.
• Non-hospital providers and suppliers will be able to request up to 100 percent of the Medicare payment amount for a three-month period – in other words, what they would expect to receive of unbilled discharges/bills over a three-month period. This will presumably be done through a three-month lookback period. The guidance does not specify how the lookback period is determined.
• Inpatient acute care hospitals, children's hospitals and certain cancer hospitals will be able to utilize a six-month period up to 100 percent of the Medicare payment amount. CAHs can request up to 125 percent of their payment amount for the six-month period. Based on the available guidance, it is not yet clear how the maximum payment amounts will be calculated.
• Finally, if the request form has been correctly and successfully submitted, each MAC will work to review and issue payments within seven calendar days of receiving the request.
• In the event that providers remain confused about the accelerated/advance payment process, all of the MACs listed in the CMS Fact Sheet have a toll-free hotline.

For more information about the CMS program expansion or assistance on how to apply or submit requests, contact one of the authors.

DISCLAIMER: Please note that the situation surrounding COVID-19 is evolving and that the subject matter discussed in these publications may change on a daily basis. Please contact your responsible Holland & Knight lawyer or the author of this alert for timely advice.

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