By Mathew J. Levy, Esq. & Zoila Sanchez, MPH (Legal Intern)
On March 28, 2020, the Centers for Medicare & Medicaid Services (CMS) announced an expansion of the Accelerated and Advance Payments Program (AAPP) to all eligible Medicare- Medicare providers and suppliers during the period of the COVID-19 public health emergency.
CMS describes the impact of the coronavirus pandemic as a “significant disruption to the healthcare industry, with providers being asked to delay non-essential surgeries and procedures, other healthcare staff unable to work due to childcare demands, and disruption to billing” causing a “significant financial burden on providers.” While the expedited payments are normally offered during a national emergency or natural disaster, CMS is authorizing the AAPP expansion during this public health emergency to all qualifying Medicare providers throughout the U.S. through a provision in the $2.2 trillion CARES Act package. Increasing the cash flow to impacted health care providers will provide them with the necessary resources to combat the COVID-19 pandemic and focus on patient care.
Providers and suppliers must meet the following eligibility requirements:
- Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form;
- Not be in bankruptcy;
- Not be under active medical review or program integrity investigation; and
- Not have any outstanding delinquent Medicare overpayments.
Applicants submit an application form through their designated MAC website. Qualifying hospitals, doctors and durable medical equipment suppliers can expect approved requests to be processed within seven (7) days.
Accelerated and advanced payments are based on historical payments and vary according to provider-type.
Critical Access Hospitals (CAH) may request a maximum of 125% of the payment amount for a six-month period. Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals may request up to 100% of the payment amount for a six-month period. Other providers may request up to 100% of the Medicare payment amount for a three-month period.
Providers/supplies begin repayment 120 days from the date the payment is issued. With respect to repaying the balance, Medicare Part A providers and Part B suppliers have 210 days (or 7 months) from date payment was issued. This timeline is extended for inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and CAHs, given a maximum of one (1) year from the accelerated payment issuance date.
Recoupment and Reconciliation:
After receiving the accelerated/advance payment, providers and suppliers can continue to submit claims and receive full payment. Recoupment begins 120 days from issuance of the payment.
The American Medical Association created a visual example of an advanced payment timeline including repayment and recoupment.
For details on AAPP application steps, see the CMS Factsheet. Additionally, on April 3, 2020, the American Hospital Association (AHA) published a CMS update and clarification addressing the specifics of payment amount determinations, repayment, recoupment and reconciliation, which CMS will publish in a FAQ.
Weiss Zarett Brofman Sonnenklar & Levy, P.C. is a Long Island law firm providing a wide array of legal services to the members of the health care industry, including corporate and transactional matters, civil and administrative litigation, healthcare regulatory issues, Medicare payment issues, bankruptcy and creditors’ rights, and commercial real estate transactions.
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