Medicare Accelerated and Advance Payment Program
April 20, 2020
By: Eric N. Fischer
Section 3719 of the CARES Act allows healthcare providers to receive advanced payments from the Medicare Program under the Centers for Medicare & Medicaid Services (“CMS”) Accelerated and Advance Payment Program (“Advanced Payments”). The Accelerated Payments apply to hospitals, physicians, and other Medicare Part A providers and Part B suppliers. The purpose of the program is to increase cash flow to health care providers and suppliers impacted by the COVID-19 pandemic. CMS may provide accelerated or advance payments to a Medicare provider/supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the required qualifications. The Advanced Payments help ensure that providers struggling as a result of COVID-19 have sufficient cash-flows to continue to operate.
To be eligible for advance payment, CMS states that providers/suppliers must meet four criteria:
- 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.
The amount of the Advanced Payment a provider/supplier can request varies. Most providers/suppliers may request up to 100 percent of the Medicare payment amount for a three-month period. Acute care hospitals, children's hospitals and certain cancer hospitals are eligible for up to 100 percent of the Medicare payments for a six-month and inpatient Critical access hospitals (CAH) can request up to 125 percent of their payment amount for a six-month period. CMS has developed a streamlined process for evaluating an application that has reduced the time to payment to between four and six days.
Unlike the CARES Act Provider Relief Fund payments, which are not required to be repaid, the Advanced Payments are a loan against future Medicare billings and must be repaid. Repayment begins 120 days after the receipt of the funds. To facilitate repayment CMS will apply claims payments to offset the balance of the Advanced Payments. The repayment obligations and claims offset will take place as follows:
- Inpatient care hospitals, children's hospitals, certain cancer hospitals and CAHs have up to one year from the date the payment was made to repay the balance.
- All other providers and suppliers have to repay the balance 210 days from the date of the payment.
The Accelerated Program functions like a short term no interest loan from CMS to allow healthcare providers to spread COVID-19 related losses over a longer period of time.
To apply for an Advanced Payment, providers/suppliers need to complete and submit a one-page request form to your servicing MAC. To locate your designated MAC, refer to this chart.
CMS has established COVID-19 hotlines at each MAC that are operational Monday through Friday to assist with Accelerated Payment requests. Wisconsin Physician Services (“WPS”) is the MAC servicing most healthcare providers in Iowa. The toll-free Hotline Telephone Number for WPS is 1-844-209-2567.
Content of Application
The provider/supplier must complete the entire form, including the following:
1. Provider/supplier identification information:
a. Legal Business Name/ Legal Name;
b. Correspondence Address;
c. National Provider Identifier (NPI);
d. Other information as required by the MAC.
2. Amount requested based on your need:
3. Reason for request:
a. Please check box 2 (“Delay in provider/supplier billing process of an isolated temporary nature beyond the provider’s/supplier’s normal billing cycle and not attributable to other third party payers or private patients.”); and
b. State that the request is for an Accelerated Payment due to the COVID- 19 pandemic.
If you have questions about whether the Accelerated and Advance Payment Program is appropriate for you or about how to apply please contact us.
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