CMS Offers Upfront Medicare Reimbursement During COVID-19 Pandemic

More healthcare providers will be able to access advanced Medicare reimbursement during the COVID-19 pandemic as CMS expands the Accelerated and Advanced Payment Program.

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On March 28, CMS announced an expansion of the Accelerated and Advanced Payment Program to a broader group of Medicare Part providers and Part B suppliers during the duration of the public health emergency declared by HHS Secretary Alex Azar in January.

The program provides expedited Medicare reimbursements to participating providers when there is a disruption in claims submissions and/or claims processing. CMS can also offer advanced payments in times of national emergency or in the event of a natural disaster.

“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.

“Unfortunately, the major disruptions to the healthcare system caused by COVID-19 are a significant financial burden on providers. Today’s action will ensure that they have the resources they need to maintain their all-important focus on patient care during the pandemic.”

Medicare provided coverage for 37.4 million beneficiaries in its fee-for-service program and made $414.7 billion in direct payments to providers in 2019. The expansion of the Accelerated and Advanced Payment Program will enable Medicare to get those payments to providers quicker in 2020.

Healthcare providers across the care continuum are facing significant operational disruptions, such as the cancelation of high-margin elective procedures, a sudden influx of COVID-19 patients, and severe supply shortages including personal protective equipment (PPE). These disruptions are creating serious cash flow issues for many organizations.

In letters to Congressional leaders earlier this month, hospital and physician practice leaders painted a dire picture of the healthcare system’s finances. The organizations said the COVID-19 pandemic is creating financial uncertainty and many organizations feared they could not meet payroll in the coming weeks.

Congress passed the Coronavirus Aid, Relief and Economic Security (CARES) Act last week, providing more than $100 billion in direct aid to hospitals and other providers, as well as a 20 percent increase in Medicare reimbursement for COVID-19 hospitalizations. Part of the act also included the expansion of the Accelerated and Advanced Payment Program.

The latest move from CMS will institute changes to the program in light of the COVID-19 pandemic.

“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,” stated 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.

Healthcare improvement company Premier also applauded the agency’s actions, saying the expansion of the Accelerated and Advanced Payment Program will “mitigate the financial stress hospitals and other providers are under due to significant declines in revenue from canceled procedures and other programs as well as the financial costs of caring for COVID-19 patients.”

However, the company expressed concerns that still face challenges with full repayment and plans to work with the Trump administration to “determine how funding available through the CARES act can be used to reduce or eliminate this obligation.”

Meanwhile, Medicare providers can apply for the upfront Medicare reimbursement through CMS. To qualify, providers and suppliers 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
• Not have any outstanding delinquent Medicare overpayments

Eligible providers and suppliers will have to request a specific amount using an Accelerated or Advance Payment Request form, which can be found on each Medicare Administrative Contractor’s (MAC) website.

CMS notes in a fact sheet that most providers and suppliers will be able to request up to 100 percent of the Medicare payment amount for a three-month period. Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals will be able to request that amount for a six-month period.

Furthermore, critical access hospitals are able to request up to 125 percent of their payment amount for a six-month period.