March 28, 2020, Alex Spanko, Skilled Nursing News - The federal government on Saturday announced an emergency action plan to offer advance Medicare fee-for-service payments, as well as accelerated reimbursements, to all Medicare Part A and B providers.
Under the terms of the emergency action, most providers who bill under Medicare Parts A and B can request up to 100% of their Medicare payment for a three-month period in advance — which they then must begin repaying 120 days after receipt.
“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 a statement.
“Unfortunately, the major disruptions to the health care 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.”
Interested providers can apply directly to their Medicare Administrative Contractor (MAC); if approved, they can expect to receive the advance payments within seven calendar days.
Health care providers that receive Medicare fee-for-service reimbursements must meet several requirements in order to receive the assistance:
- The applicant must have billed for Medicare services at some point within 180 days prior to submitting the application
- The applicant cannot be in bankruptcy
- The applicant cannot be under an active medical review or program integrity investigation
- The applicant cannot have outstanding delinquent Medicare overpayments
The three-month payment amount applies to most providers, while certain settings — such as acute care, children’s, and cancer hospitals — can receive 100% of their reimbursements for a six-month period.
Critical access hospitals (CAHs), which can provide skilled nursing care under the “swing bed” model, can ask for up to 125% of their reimbursement over a six-month period, according to the government.
It’s important to note that the assistance represents an advance, and not a boost: Once the 120-day period is over, subsequent claims will be used to pay off the advance balance.
“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,” according to the Centers for Medicare & Medicaid Services (CMS).
“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.”
CMS is legally allowed to offer advance and accelerated payments in certain situations, typically in the event of a natural disaster or other national emergency.
The agency framed the Saturday announcement as a way to provide direct relief to operators that may have experienced income and payroll disruptions due to the ongoing pandemic.
“There has been significant disruption to the health care industry, with providers being asked to delay non-essential surgeries and procedures, other health care staff unable to work due to childcare demands, and disruption to billing, among the challenges related to the pandemic,” CMS observed.