by Wyn Staheli, Director of Research
April 13th, 2020
The recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act has several provisions to ease the financial burden being faced by healthcare providers who have been impacted by the effect of the coronavirus. Some key provisions include:
- $100 billion in direct financial aid to 1,381 HRSA-funded health centers which includes the Provider Relief Fund described below (Special Public Health and Social Services Emergency Fund Allocation)
- $1.3B for supplemental awards targeted to community health centers for detection, prevention, diagnosis and treatment of COVID-19 (Section 3211)
- Medicare sequester 2% reduction lifted from May 1st to December 31st (Section 3709)
- Medicare Hospital Inpatient Prospective Payment System add-on payment of 20% (DRG weighting increases) for COVID-19 patients (Section 3710)
- DME payment reductions suspended (Section 3712)
- Hospitals can elect to receive up to 100% of Medicare prior period payments (125% for critical access hospitals) for up to a 6-month period, as an advance, with loan repayment not starting for four (4) months and have twelve (12) months to repay without interest (Section 3719)
The remainder of this article covers two topics which apply to many, if not all, healthcare providers and organizations billing Medicare.
Provider Relief Fund
As part of the CARES Act, the Department of Health and Human Services (HHS) has begun distributing $30 billion. Beginning on April 10th, eligible providers (including chiropractors) will be paid an amount (based on their 2019 Medicare receipts) via a check or direct deposit (depending on how they usually are reimbursed by Medicare. These payments are not loans which need to be repaid. If you or your organization received Medicare fee-for-service (FFS) payments in 2019, you are technically eligible. Payments will be made to the Taxpayer Identification Number (TIN) listed on the submitted claims.
There is one catch: you have to agree to abide by their Term and Conditions. For more information about eligibility and these terms and conditions, CLICK HERE. It should be noted that even though the Terms and Conditions state that the provider certifies that it “currently provides diagnoses, testing, or care for individuals with possible or actual cases of COVID-19”, the HHS “CARES Act Provider Relief Fund” website page states (emphasis added), “Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.” To limit potential future audit concerns, documentation of the patient encounter should mention that certain risk-reduction measures were implemented due to potential exposure to COVID-19.
If you don’t want to worry about this issue or don’t agree to the Terms and Conditions, then you must contact HHS within 30 days of receipt of payment and then return the full payment to HHS as instructed. Not returning funds means that you agree to their terms.
Accelerated and Advance Payment Program
This program is different from the Provider Relief Fund program explained above. This is basically a loan for which the provider applies and which they must repay. Healthcare providers need to complete an application where they specify a requested amount. CMS stated that “ Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period.” Some organizations may be able to request more.
For a more comprehensive explanation, CLICK HERE.