Policy Update: Updates on Funding from 2019 and 2020

August 2, 2021

As we await with bated breath (please don’t let it drop while we are on vacation) the 2022
Physician Fee Schedule, we have two updates on funding from 2019 and 2020.

Provider Relief Fund Reporting Portal is Now Open – Closes September 30th

At the beginning of the pandemic (mid-April), many practices automatically received a payment
from the Provider Relief Fund (PRF) that was about 2% of their Medicare billing. A second and
third round of funding was also available from the PRF for practices that submitted applications
and met the necessary criteria- primarily being able to show a loss in revenue between 2019 and
2020. The full amount of funds you’ve received from the Provider Relief Fund can be found in this dataset.

After more than a year of waiting, Health and Human Services (HHS) has finally released the
reporting requirements for practices that received funds from the PRF. The reporting portal
opened July 1st and practices have until September 30th to submit their first report. HHS has
made available many resources to practices, including a webinar on July 8th, FAQs, and data entry worksheets.

Over the next few weeks, Aledade will be releasing an FAQ and more information as we hear
about common pain points from you.

Advanced Alternative Payment Model Bonus Payments Made

For those practices that were in a risk taking ACO in 2019, even if you started in July, you should
have received your AAPM bonus equal to 5% of your Part B revenue (excluding drugs). The
payment was labeled “CMS QPP.” Below are a few common questions we have gotten:

  • Q: How do I find out what each individual physician, NP, PA, or CNS made?
    • The ACO cannot see individual amounts. However, we did get some instructions
      from a practice on how they looked it up.
    • Go to the qpp.cms.gov website > Login > On the Home screen click on “APM
      Incentive Payment” (located on the left side panel) > Click on the drop-down option
      for “Performance Year” (2017,2018, & 2019) (located in the middle of page) > The
      information will display below, then click on “View Payment Details”-this shows the
      provider and amount paid.
  • Q: I wasn't in an AAPM ACO, why did I receive a small bonus?
    • Most likely, you had a provider who was in an AAPM in 2019, but has since moved
      to your practice. There are multiple steps CMS follows to try and figure out what TIN
      that NPI is currently practicing at. The bonus follows the physician, PA, NP, or CNS
      in CMS’s rules. Employment contracts could require rerouting by the physician, PA,
      NP or CNS after delivery.
  • Q: What if I did not get a bonus, but I believe I should have?
    • CMS is not always able to identify an active TIN for providers who earned an AAPM bonus. They have published a list of these providers as well as the steps you must take to receive your bonus (File Name: 2021 QP Notice for APM Incentive Payment Zip File). We will also review this list.