Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Section 3719

By Denis Houle April 3, 2020

Expansion of the Medicare Hospital Accelerated Payment Program during the COVID-19 public health emergency

Section 3719 amended Section 1815 of the Social Security Act (42 U.S.C. 1395g). In order to increase cash flow to providers and suppliers impacted by the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) is expanding the Accelerated and Advance Payments program.

Accelerated/Advance payments:

An accelerated/advance payment is intended to provide necessary funds when there is a disruption in claims submission and/or claims processing. However, these expedited payments can also be offered in circumstances such as national emergencies.

CMS has been authorized to provide accelerated or advance payments during the COVID-19 crisis to any Medicare provider or supplier who submits a request to their Medicare Administrative Contractor (MAC) and meets the required qualifications.

Eligibility:

To qualify for accelerated/advance payments, the provider/supplier 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

Amount of payment:

Qualified providers and suppliers are to use the 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.

• 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 can request up to 125% of their payment amount for a six-month period
• Medicare Part B providers can request up to 100% of their payment amount for a three-month period

Processing time:

Each MAC will work to review and issue payments within seven calendar days of receiving the request.

Repayment:

CMS has extended the repayment of these accelerated/advance payments to begin 120 days after the date of payment issuance. The repayment timeline is broken out by provider type as follows:

• Inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals have up to one year from the date the accelerated payment was made to repay the balance
• All other Part A provider and Part B suppliers will have 210 days from the date the accelerated or advance payment was made to repay the balance

Recoupment and reconciliation:

• Providers and suppliers will receive full payments for their claims during the 120-day delay period. 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/advance payment. Therefore, 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.
• The majority of hospitals, including inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals, will have up to one year from the date the accelerated payment was made to repay the balance. At one year from the accelerated payment receipt, the MACs will perform a manual check to determine if there is a balance remaining, and, if so, send a request for repayment of the remaining balance. All other Part A providers not listed above, and Part B suppliers, will have up to 210 days for the reconciliation process to begin.
• For the small subset of Part A providers who receive Period Interim Payments (PIP), the accelerated payment reconciliation process will happen at the final cost report process (180 days after the fiscal year closes).

Key takeaways:

• Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals
  • Payment amount: Up to 100% of the Medicare payment amount for a six-month period
  • Repayment: Up to one year from the date the accelerated payment was made (beginning 120 days after the date of payment issuance)
• Critical access hospitals
  • Payment amount: Up to 125% of the Medicare payment amount for a six-month period
  • Repayment: Up to one year from the date the accelerated payment was made (beginning 120 days after the date of payment issuance)

• All other Part A providers and Part B suppliers
  • Medicare Part B providers can request up to 100% of their payment amount for a three-month period
  • Repayment: Up to 210 days from the date the accelerated payment was made (beginning 120 days after the date of payment issuance
• MACs will work to review and issue payments within seven calendar days of receiving the request

More information, and a step by step application guide, the CMS Fact sheet can be found here.

FOR MORE INFORMATION, PLEASE CONTACT THE FOLLOWING MEMBERS OF OUR HEALTHCARE ADVISORY GROUP:

• Denis Houle: Senior Manager
• Marc Levy: Senior Manager