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CMS Expands Payment Program to Provide Labs Temporary Relief from Declining Revenues

  • Senior Product Manager, XIFIN

Due to the impact of the recent coronavirus pandemic, CMS Administrator Seema Verma has expanded the CMS Accelerated and Advance Payment Program for the duration of the public health emergency.1 The streamlined process designed to assist healthcare providers and suppliers “stay afloat” during the current COVID-19 crisis will now take days rather than weeks for requests to be processed. For Medicare Part B providers, the Accelerated Program is being funded by the Supplemental Medical Insurance trust fund. This fund is separate from the Corona Virus Aid, Relief, and Economic Security (CARES) Act signed into law on Mar 27th, 2020.2

The accelerated and advance payments are loans that Medicare Part B providers must pay back within 210 days of receiving the funds. Up to 100% of the total amount of three months Medicare claims can be requested. After 120 days of funds disbursement, CMS will begin applying claims payments to offset the loan amount for new claims and claims submitted during the initial 120-day operating period. The fact sheet for the program can be found here:

Eligibility criteria for the program include providers that:

  • Have billed Medicare within 180 days immediately prior to request submission
  • Are not in bankruptcy
  • Are not under active medical review or integrity investigation
  • Have no delinquent or outstanding Medicare overpayments

Eligible providers should submit requests for loan amounts to their appropriate Medicare Administrative Contractor (MAC). Each MAC has its own request form available on their individual websites. To locate your jurisdiction’s appropriate MAC, refer to Medicare Administrative Contractors (MACs) As of June 2019.

The estimated processing time for review is seven calendar days once the request has been received. Incomplete forms will not be processed. The CMS fact sheet states that the requestor should:

“1. Check box 2 (“Delay in provider/supplier billing process of an isolated temporary nature beyond the provider’s/supplier’s normal billing cycle and not attributable to other third-party payers or private patients.”); and

2. State that the request is for an accelerated/advance payment due to the COVID19 pandemic”

as the reason for the request.

We are all in this crisis together and are grateful for all the efforts of our healthcare providers, institutions, and individuals for keeping us safe and healthy.

Sources:

  1. https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
  2. https://www.whitehouse.gov/briefings-statements/remarks-president-trump-signing-h-r-748-cares-act/

To learn more about the latest testing, testing supply needs, and payor billing requirements related to COVID- 19, visit our COVID-19 Laboratory Resource Center.
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Published by XIFIN
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