CMS Expands Medicare Accelerated Payment Program to Help with COVID-19 Cash Flow Challenges

Health care policymakers are already taking advantage of the recently enacted Coronavirus Aid, Relief and Economic Security (CARES) Act to help out Medicare-reimbursed providers struggling with cash flow.

On Saturday, the U.S. Centers for Medicare & Medicaid Services (CMS) announced it was expanding its accelerated and advance payment program for Medicare providers, citing a need to further support the organizations on the frontline battling COVID-19. For home health providers, COVID-19 has affected cash flow in a variety of ways, with many burning through months’ worth of supplies in mere days and others seeing patients refuse visits.

“With our nation’s health care providers on the front lines in the fight against COVID-19, dollars and cents shouldn’t be adding to their worries,” CMS Administrator Seema Verma said in a statement.

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Accelerated and advance Medicare payments generally provide emergency funding based on historical payments when there is disruption in claims submission or claims processing.

Normally, expedited payments are offered when providers struggle due to hurricanes, tornadoes and other natural disasters. With Saturday’s announcement, CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.

The payments, according to CMS policies, can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers.

“Unfortunately, the major disruptions to the health care system caused by COVID-19 are a significant financial burden on providers,” Verma. “Today’s action will ensure that they have the resources they need to maintain their all-important focus on patient care during the pandemic.”

While most types of Medicare providers and suppliers can request accelerated payments, there are several conditions those parties must meet.

To qualify for accelerated or advance payments, providers and suppliers must have billed Medicare for claims within 180 days immediately prior to any request. Providers in bankruptcy are not eligible for accelerated payments, nor are providers under active medical review or program integrity investigation.

Providers with outstanding delinquent Medicare overpayments are also not allowed to ask for advance payment.

Medicare will start accepting and processing the accelerated and advance payment requests immediately, according to CMS. The agency anticipates that the payments will be issued within seven days of a provider’s request.

Under accelerated payment rules, most providers and suppliers will be able to request up to 100% of their Medicare reimbursement amount for a three-month period, according to CMS. After 120 days from when they received an accelerated payment, home health providers will then have 210 days to repay their balance.

While CMS did not specify how exactly, it said the CARES Act — the $2 trillion stimulus package signed into law Friday — supported its ability to expand the advance payment program. Broadly, the action signals CMS’s willingness to promptly take additional relief actions on behalf of home health providers and other Medicare organizations.

That could mean non-physician certification is right around the corner for an industry that’s been calling for that flexibility for more than a decade. Congress gave CMS the go-ahead to launch non-physician home health certification by including the Home Health Care Planning Improvement Act within the framework of the stimulus package.

Another possible action CMS could take to support home health providers’ cash flow: a rewind on its plan to phase out Requests for Anticipated Payment (RAPs).

Dr. Steven Landers — president and CEO of New Jersey-based VNA Health Group — proposed that idea during a Home Health Care News interview earlier this month.

“If we have all this revenue uncertainty coupled with unpredictable ups and downs in patient census, taking steps to keep cash flow strong would be helpful,” Landers said. “I think [CMS] should do something easy and go back to what they were doing in December, specifically with respect to RAPs.”

VNA Health Group is the largest independent, nonprofit provider of home-based health services in New Jersey and parts of Ohio.

Getting more of the home health payment up front rather than at the end of an episode would allow agencies to better manage expenses and payroll throughout the duration of the coronavirus emergency, Landers said.

“We just really need to all come together and figure out how we can keep our services strong, our people healthy,” he previously told HHCN. “This is unprecedented.”

Overall, Medicare provides coverage for 37.4 million beneficiaries in its fee-for-service program. In total, Medicare made $414.7 billion in direct payments to providers during 2019.

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