Author: Tony Mira
The Centers for Medicare and Medicaid Services (CMS) has released a fact sheet explaining how it intends to put money directly into the hands of professional clinicians and hospitals whose surgical caseloads—and income—have plummeted due to the coronavirus (COVID-19) outbreak. According to the fact sheet, “CMS is authorized to provide accelerated or advance payments during the period of the public health emergency to any Medicare provider/supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the required qualifications.“
What the Program Provides
Most importantly, the CMS notification outlines the amount of money the provider can expect. The fact sheet states in pertinent part: “Qualified providers/suppliers will be asked to request a specific amount using an Accelerated or Advance Payment Request form provided on each MAC’s website. Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period.” You can expect review and payment within seven days of the request.
While Medicare will provide advances during this emergency period, providers will still be submitting and getting reimbursed for actual services performed. Any advance payments received will need to be repaid down the road. The fact sheet advises the following: “CMS has extended the repayment of these accelerated/advance payments to begin 120 days after the date of issuance of the payment.” So, by what mechanism is this repayment to occur? The fact sheet continues: “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.”
To qualify for the advanced payments, the provider must meet ALL of 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.
Once you have determined that all of these standards have been met, you can then begin the process of requesting the advance payment, if you so choose. That process is described in the following section.
Requesting Advance Payment
The CMS fact sheet contains specific and detailed steps that the provider must follow to request accelerated/advanced payments. We have reprinted the most salient section of those instructions, below.
- Complete and submit a request form: Accelerated/Advance Payment Request forms vary by contractor and can be found on each individual MAC’s website. Complete an Accelerated/Advance Payment Request form and submit it to your servicing MAC via mail or email. CMS has established COVID-19 hotlines at each MAC that are operational Monday – Friday to assist you with accelerated payment requests. You can contact the MAC that services your geographic area. To locate your designated MAC, refer to https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Downloads/MACs-by-State-June-2019.pdf.
- What to include in the request form: Incomplete forms cannot be reviewed or processed, so it is vital that all required information is included with the initial submission. The provider/supplier must complete the entire form, including the following:
- Provider/supplier identification information:
- Legal Business Name/ Legal Name;
- Correspondence Address;
- National Provider Identifier (NPI);
- Other information as required by the MAC.
- Amount requested based on your need:
- Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period. However, inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100% of the Medicare payment amount for a six-month period. Critical access hospitals (CAH) can now request up to 125% of their payment amount for a six-month period.
- Reason for request:
- 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
- State that the request is for an accelerated/advance payment due to the COVID19 pandemic.
- Provider/supplier identification information:
- Who must sign the request form? The form must be signed by an authorized representative of the provider/supplier.
- How to submit the request form: While electronic submission will significantly reduce the processing time, requests can be submitted to the appropriate MAC by fax, email, or mail. You can also contact the MAC provider/supplier helplines.
Other Items to Note
Your Medicare administrative contractor will notify you as to whether the request is approved or denied via email or mail (based on your preference). If the request is approved, the payment will be issued by the contractor within 7 calendar days from the request.