Accelerated/Advance Payments to Providers Are On the Way

April 8, 2020Alerts

The Centers for Medicare and Medicaid Services (CMS) has started the flow of funds to health care providers in an expansion of the Accelerated/Advance Payment Program, with nearly $34 billion advanced so far. CMS received more than 25,000 requests in the first week following its March 28, 2020 announcement that it was expanding the program for providers and suppliers during the COVID-19 emergency. More than 17,000 of the first 25,000 requests were approved last week according to an April 7, 2020 CMS Press Release

Accelerated/Advance payments are available to Part A providers, including acute care hospitals, long-term acute care hospitals, and skilled nursing facilities, as well as Part B suppliers, including physicians, non-physician practitioners, and durable medical equipment suppliers.

Eligibility Requirements

According to the CMS Fact Sheet, to be eligible, a provider or supplier must have billed Medicare for claims within the past 180 days and must not:

  • be in bankruptcy
  • be under active medical review or a program integrity investigation
  • have any outstanding delinquent Medicare overpayments

The provider or supplier must request a specific amount, which can be up to 100 percent of its Medicare payment amount for a three-month period in most cases. Inpatient acute care, children’s and certain cancer hospitals can request up to 100 percent of their Medicare payment amount for a six-month period, and critical access hospitals can request up to 125 percent of their Medicare payment amount for a six-month period. 

Expedited Processing

The processing time is now one week, compared to three or four weeks in the past. The approval will come by mail or e-mail, based on the preference listed in the application. There are no appeal rights for a denial of a request for accelerated payments.

Repayment Time Frames

This money is separate and apart from the $30 billion in Cares Act funds earmarked for health care providers. Unlike the Cares Act funds, the Accelerated/Advance payments are essentially a loan that must be repaid, and offsets will begin automatically 120 days after the funds are disbursed. In other words, the provider or supplier will continue to submit claims, and, after 120 days, the provider or supplier’s outstanding accelerated/advance payment balance will be reduced by the claim payment amounts. Most hospitals will have up to one year from the date the accelerated payment was made to repay the accelerated amount. Other Part A providers and Part B suppliers will have up to 210 days to repay the accelerated amount.

The Fact Sheet includes a step-by-step guide on how to request payments, and each Medicare Administrative Contractor (MAC) has its own Request Form, available on its website. CMS also has set up COVID-19 hotlines at each MAC to assist Monday through Friday.