On March 28, 2020, CMS released guidance related to the expanded accelerated and advance payments provided under the Coronavirus Aid, Relief, and Economic Security (CARES) Act signed into law by President Trump on March 27. These payments are typically available when there is a disruption in claims submission or claims processing, and are offered in limited circumstances, such as a natural disaster.  In the CARES Act Congress expanded CMS’ ability to use these types of payments, and CMS has developed a strategy to “increase cash flow to providers of services and suppliers impacted by the 2019 Novel Coronavirus (COVID-19) pandemic.”

The CMS fact sheet helps providers and suppliers navigate the payment process and submit an immediate request. Inpatient hospitals – including Acute Care, Children’s, and Cancer hospitals – may request up to 100% of their Medicare payment amount for a six-month period (through their designated Medicare Administrative Contractor or MAC). Critical access hospitals may request up to 125% for the same time period, and other providers and suppliers may request up to 100% of their Medicare payment for 3 months. CMS anticipates that each MAC will review and issue payments within 7 days of receiving a request, and repayment will begin 120 days after payment is issued through recoupment.  The MAC will automatically offset every new claim submitted after the 120-day period from the advance payment balance.  Most hospitals will have up to one year to repay the amount, and other Part A providers and Part B suppliers will have 210 days from the date the payment was made.

To be eligible for the accelerated or advance payments, providers and suppliers must: have billed Medicare less than 180 days prior to submission, not be in bankruptcy or under investigation (either active medical review or program integrity), and not have outstanding delinquent Medicare overpayments due to CMS. Submissions should indicate their reason as a “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 that “the request is for an accelerated/advance payment due to the COVID-19 pandemic.” There are no general administrative appeal rights extended to these payments, but providers will be able to appeal an overpayment determination made by CMS.

Norton Rose Fulbright attorneys will continue to follow on a daily basis COVID-19-related developments pertinent to health care providers and publish regular updates in the Health Law Pulse.