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CMS Expands Accelerated and Advance Payment Program

On March 28, 2020, the Centers for Medicare & Medicaid Services (CMS) announced an expansion of its Accelerated and Advance Payment Program (the Program). The Program is designed to help providers with “significant cash flow problems resulting from…unusual circumstances of the hospital’s operation.” 42 U.S.C. § 1395g (e)(3). Usually deployed during times of natural disasters, the recently enacted CARES Act directed CMS to expand the Program to providers who have been adversely affected by the COVID-19 public health emergency.

The Program allows CMS to make what are essentially short-term, zero interest loans to providers and suppliers in the form of advance payments. Providers who receive an accelerated/advance payment will have a 120-day period before they begin repaying CMS. Providers and suppliers will continue to receive full payment for Medicare claims submitted during this 120-day period.  After the initial 120-day period, CMS will recover the accelerated/advance payments via a recoupment and reconciliation process, through which the accelerated/advance payment amounts are deducted from new claims. At a certain date, each provider and supplier who received accelerated/advance payments under the Program will be required to pay back any remaining balance. Eligibility details, payment amounts, repayment timelines, and the application process are explained in more detail below.

Eligibility

According to CMS, eligible providers or suppliers must,

  1. Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form;
  2. Not be in bankruptcy;
  3. Not be under active medical review or program integrity investigation; and
  4. Not have any outstanding delinquent Medicare overpayments.

Potential Advance Payment Amounts

  1. Critical access hospitals may request up to 125% of their Medicare payment amount for a 6-month period.
  2. Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals may request up to 100% of their Medicare payment amount for a 6-month period.
  3. All other providers and suppliers may request up to 100% of their Medicare payment amount for a 3-month period.

Repayment Timeline

All providers and suppliers who receive an advance payment must begin to repay CMS 120 days after receiving their payment.

  • Inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals, will then have 1 year from the date they received the accelerated payment to repay the balance to CMS.
  • All other providers and suppliers will have 210 days from the date they receive the accelerated payment to repay the balance to CMS.

The repayments will work as described above. Essentially, the advance payment will create a negative balance with CMS. Provider or supplier claims submitted to CMS after the 120-day delay period until the applicable repayment date will be applied to lower the balance with CMS instead of the provider being paid. The provider or supplier will pay any balance left over in a lump sum at the end of the repayment period. The repayment process will be handled automatically.

Application Process

Interested providers and suppliers may apply for an accelerated payment by completing and submitting an Accelerated/Advance Payment Request form through their individual Medicare Administrative Contractor (MAC). Applications may be filled out online, or submitted by email, fax, or mail. Submissions must include identification information, the amount being requested, and a reason for the request. CMS has provided specific instructions on how to fill out and submit the request form here. Additionally, each MAC has set up a hotline to answer questions and help with the application process. CMS has indicated that approved applicants should receive payment within 7 days of the MAC’s receipt of the request form.

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About this Author

Robert Nauman, Health Care, Lawyer, Squire Patton Boggs
Principal

Robert has extensive experience counselling healthcare clients, including hospitals and health systems, physicians, physician groups, ambulatory surgery centers, insurers, health plans and management companies, in a variety of regulatory and transactional matters.

Robert’s areas of expertise include healthcare fraud and abuse laws, Medicare reimbursement issues, provider alignment strategies, provider enrollment, accreditation and licensure, Accountable Care Organizations, provider acquisitions and affiliations, healthcare antitrust matters,...

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Bevan Blake Associate  Columbus  Medicare and Medicaid, corporate matters
Associate

Bevan Blake assists clients in a broad range of corporate matters, including mergers and acquisitions, corporate compliance, joint ventures and reorganizations. He has experience in the healthcare industry, advising clients on regulatory requirements and Medicare and Medicaid rules.

614-365-2827