The Centers for Medicare and Medicaid Services (CMS) has announced the expansion of its accelerated and advance payment program under the recently enacted Coronavirus Aid, Relief and Economic Security (CARES) Act. Even as medical billing service providers work to help physicians with their revenue cycle management, the COVID-19 crisis has caused considerable disruption in the healthcare industry. The accelerated and advance payment program delivers emergency funding and addresses cash-flow issues during emergencies by providing payments based on historic performance, to be offset by future claims.

“With our nation’s health care providers on the front lines in the fight against COVID-19, dollars and cents shouldn’t be adding to their worries,” CMS Administrator Seema Verma said in the announcement.

Healthcare providers are facing multiple operational challenges due to cancelation of high-margin elective procedures, sudden inflow of COVID-19 patients, severe supply shortages, and disruption in claims submission and/or claims processing. Covid-19 cases and hospitalizations continue to surge. Confirmed U.S. cases are now rising at a rate of about 20,000 a day, according to a Barron’s news report dated March 30.

CMS has expanded its accelerated and advance payment program to all Medicare providers and suppliers throughout the country. The program provides more than $100 billion in direct aid to hospitals and other providers, and also a 20 percent increase in Medicare reimbursement for COVID-19 hospitalizations. The payments can be requested by hospitals, physicians, durable medical equipment suppliers, and other Medicare Part A and Part B providers and companies.

  • Eligibility: To qualify for accelerated or advance payments, providers and suppliers must meet the following 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
    • Not have any outstanding delinquent Medicare over payments
  • Amount of Payment: Most physician practices can 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 6-month period. Critical access hospitals can request up to 125% of their payment amount for a 6-month period.
  • Time: CMS announced that it would started accepting and processing payment requests with immediate effect and that checks will be dispensed within seven days of the request.
  • Repayment: Repayment is set to begin 120 days after the payment is issued, and entities can continue to submit claims as usual. They will receive full payments for their claims during that period.
  • Claim Submission: Providers can submit claims as usual after the advance payment has been issued to them. Providers/ suppliers will receive full payments for their claims during the 120-day delay period.
  • Recoupment: The recoupment process will begin after 120 days from the provider’s/supplier’s claim payment amount. All claims submitted by the provider or supplier will be offset from the new claims to repay the accelerated/advance payment. In this way, the provider’s or supplier’s outstanding accelerated/advance payment balance will be reduced automatically by the claim payment amount, explains MedScape.

While most hospitals will have up to 1 year from the date the accelerated payment was made to repay the balance, nonhospital Part A and Part B health care providers will have 210 days from the payment date to repay the balance.

The American Medical Association has lauded CMS for its actions.

“Practicing medicine is harrowing and dangerous in the face of the pandemic, but less noticed is the fiscal peril that many practices face. 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,” said Patrice A. Harris MD, MA, president of the American Medical Association.

“The action is a timely recognition that flexibility is needed at all levels to respond nimbly and effectively to COVID-19,” Harris added.

Outsourcing medical billing and coding during this public emergency can help providers manage Medicare claim submission efficiently.