November 19, 2020
What does an accelerated payment accomplish?
Medicare providers will be able to request up to 100 percent of Medicare payments for three months on an accelerated basis. Essentially, CMS will pre-pay three months of claims based on historical spending and continue to pay, in full, any claims you send in for telehealth and other sources.
Four months (120 days) after the payment, CMS will stop paying claims in full and begin the process of repaying the advance by deducting the amount of the claims from the balance of the payment. Therefore, we shouldn’t see this as a stimulus, per se, more as a cash flow bridge to help you to get to an SBA loan and eventually to shared savings payments (if applicable).
How will the MAC determine if your practice qualifies for accelerated payments?
- Has billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s or supplier’s request form,
- Is not in bankruptcy,
- Is not under investigation
- Does not have any outstanding delinquent Medicare overpayments.
Some of the forms from Medicare Administrative Contractors (MACs) are old and make it seem like the practice must demonstrate negative cash flow in the next 30 days. This is not the case. Fill out the form accurately even if you do not expect a negative cash flow in the next 30 days.
How do I determine much to ask for?
There are two options:
- Ask for the maximum amount allowed which will be calculated by the MAC; or
- Ask for less than the projected maximum amount.
- Aledade can provide what your 2019 Medicare revenue was for April, May, June as a guide for your determination
- When asking for what a practice thinks is less than the maximum they should ask for “Practice Requested Amount or the maximum whichever is lesser” to ensure that the application is not rejected because it exceeds the maximum
When will I receive the payment?
Medicare has directed the MACs to direct deposit the amount within 7 days of the application. Whether they will meet that timeline remains to be seen.
What happens to my claims after I receive the payment?
For the next 120 days after you receive the accelerated payment you will continue to receive full payment for any claim you submit. You will have both the accelerated payment representing 3 months of claims and claims for services billed coming in.
At 121 days (date of service) you will no longer receive payment for claims you submit. The claims will instead start to pay back the accelerated payment. At 210 days, any outstanding balance on the accelerated payment while be invoiced to the practice and claims will resume paying as normal.
These timelines are based on the theory that in three months we will be back to quasi-normal. If that is not the case then we expect these payments to be pushed out.
How do I manage this cash flow?
In addition to the advance, we recommend that practices also apply for an SBA loan. The goal for practices should be to bank as much of the accelerated payment and loan funding as possible and utilize claims revenue to the extent possible. Even if you expect to not need the reserve, better have it in the bank now rather than have to request it later. This will make the repayment period much easier on your finances. This accelerated payment creates a safety net for near-term cash flow problems, but does not increase your available revenue for 2020. Aledade has resources on SBA loans and the CARES Act that will actually increase your available cash for 2020.
Your Medicare cash flow will drop to zero four months after you receive your accelerated payments. You must plan accordingly for that future by shoring up a capital reserve before it happens.
Completing the Application
The application is done at your Medicare Administrative Contractor. Please select your state.
Three most important elements are:
- Select the box “Delay in provider/supplier billing process is of an isolated temporary nature beyond the provider/supplier’s normal billing cycle”
- If the form does not mention COVID-19, call it out specifically.
- Request the maximum payment amount as calculated by CMS or the lesser of a requested amount or that amount
- Example 1: “COVID-19 has significantly, but temporarily reduced our Medicare billing. We are requesting the maximum payment amount as calculated by CMS.”
- Example 2: “COVID-19 has significantly, but temporarily reduced our Medicare billing. We are requesting the lesser of $X or the maximum payment amount as calculated by CMS.”
Kentucky
MAC: CGS
Submission Method: email: CGS.ERS.CORR@cgsadmin.com
Phone Number: 1.855.769.9920
Form: click here
Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas
MAC: Novitas
Submission Method: Provider Enrollment Gateway
Phone Number: 1-855-247-8428
Form: click here
Delaware, D.C., Maryland, New Jersey, Pennsylvania
MAC: Novitas
Submission Method: Provider Enrollment Gateway
Phone Number: 1-855-247-8428
Form: click here
Alabama, Georgia, Tennessee (JJ)
MAC: Palmetto GBA
Submission Method: Email: JJ.FINANCIALRELIEF@palmettogba.com
Phone Number: 1-833–820–6138
Form: click here
North Carolina, South Carolina, Virginia, and West Virginia (JM)
MAC: Palmetto GBA
Submission Method: Email: JM.FINANCIALRELIEF@palmettogba.com
Phone Number: 1-833–820–6138
Form: click here
California, Hawaii, Nevada
MAC: Noridian
Submission Method: Email: PartBAdvancePayments@noridian.com
Phone Number: 1-866-575-4067
Form: Click here
Florida, Puerto Rico
MAC: First Coast
Submission Method: Provider Enrollment Gateway
Phone Number: 1-855-247-8428
Form: click here
Michigan, Indiana, Kansas, Nebraska, Missouri, Iowa
MAC: WPS
Submission Method: AccAdvPymtReq@wpsic.com
Phone Number: (844) 209-2567
Form: click here
Disclaimer: Aledade endeavors to provide the most recent, actionable information pertaining to the quickly evolving state of emergency around COVID-19. Aledade regularly reviews a variety of publicly available health sources and updates its materials accordingly. Because data, regulations, and official pronouncements around COVID-19 change so frequently, however, some information contained herein may become outdated before we get the chance to update it. For the very latest on this topic please continue to use online resources from the SBA, CMS, and the U.S. Treasury Department.