National Telehealth Policy Resource Center Synopsis
Shelton, CT (March 30, 2020) On March 28, 2020, The Centers for Medicare & Medicaid Services (CMS) announced an expansion of its existing accelerated payment program (“APP”) following the passage and signing of the CARES Act.
The focus of the expansion is to help providers access funding needed to support cash flow and operations during the COVID-19 pandemic by allowing them to request interest-free payment advances. Qualified advanced payments may be received in as little as seven days.
Below we have summarized eligibility, funding amounts, processing and repayment details pertinent to Medicare Part B office-based practices, nursing facility practices and Post-Acute providers. Full details can be found in the Fact Sheet provided by CMS.
Accelerated/Advance Payments are intended to provide necessary funds when there is a disruption in claims submission and/or claims processing or in the event of a national disaster or emergency, to any Medicare provider who submits a request to their Medicare Administrative Contractor (MAC) and meets the required qualifications. Both the CMS Fact Sheet and a link further below provide the contact information for each MAC.
To be eligible for an advanced/accelerated payment as a provider or provider group you must:
- 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.
Amount of Payment: You will be able to request a specific amount up to 100% of the Medicare payment amounts you would normally receive for a three-month period.
Processing Time: Most payments will be issued within seven (7) calendar days of receiving the application after CMS has reviewed and approved your request.
Repayment: Providers will begin to make repayments to CMS starting 120 days after the date of issuance of the advance payment. All Medicare Part B suppliers will have 210 days from the date of the accelerated or advance payment was made to repay the balance. This means that all funds that you have received must be repaid over a 90-day period.
Recoupment and Reconciliation: Your practice can and will continue to submit claims as usual after the issuance of the accelerated or advance payment. Beginning after 120 days from this date, CMS will begin to recoup the funds paid through a recoupment method. You will receive full payments for claims during the 120-day delay period and at the end of the 120-day period, recoupment begins, and every Medicare claim submitted by your practice offset against the borrowed amount to repay the accelerated/advanced payment.
To request an accelerated or advance payment first click below to locate your designated MAC:
Each MAC may have their own form for making the request. When completing the form, you must complete all the required fields on the form, including the following:
Amount requested based on your need
Reason for request (Please check box 2 and state that the request is for an accelerated/advance payment due to the COVID-19 pandemic)
Authorized representative’s signature
Requests may be submitted electronically or via fax, email, or mail. Submission is recommended electronically to expedite the review of your request.
The MAC will notify the you by email or mail, based on your preference, to confirm whether your request is approved or denied.
As a provider, you will not have administrative appeal rights related to these payments. However, CMS has stated that you will have administrative appeal rights to the extent CMS issued overpayment determinations to recover any unpaid balances on accelerated or advance payments.
If you have further questions on the process or whether submission is the right thing for your practice contact us at 203-567-5260 or info@saisystems.com.