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Written by: Miranda Preston

In response to COVID-19, the Secretary of the U.S. Department of Health and Human Services (HHS) declared a public health emergency on January 31, 2020 (the “Public Health Emergency”).  On March 28, 2020, Centers for Medicare & Medicaid Services (CMS) announced that it was expanding its Accelerated and Advance Payment Program (the “Program”) to a broader group of Medicare Part A providers and Part B suppliers for the duration of the Public Health Emergency.  CMS’s stated objective for the Program’s expansion is to increase cash flow to service providers and suppliers impacted by COVID-19.

This article provides an overview of the expanded Program and information about how to request advanced Medicare reimbursement.

Eligibility Requirements

To qualify for advance payments, providers must: (1) have billed Medicare for claims within 180 days immediately prior to the request; (2) not be in bankruptcy; (3) not be under active medical review or program integrity investigation; and (4) not have any outstanding delinquent Medicare overpayments.

How to Request Advance Payment

To request advanced payment under the Program, healthcare providers must submit the applicable request form to their applicable Medicare Administrative Contractor (MAC).  Each MAC may have its own, distinct request form. A request form is available on each MAC’s website. Noridian is Arizona’s MAC and its request form is available here.  The request forms must be signed by an authorized representative of the healthcare provider, and can be submitted to the appropriate MAC via email, fax or mail.  Request forms submitted electronically are likely to be processed faster than their non-electronic counterparts.

In the request form’s “Reason for Request” field, CMS has directed providers to state: (1) the request is due to 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 (2) the request is for an accelerated/advance payment due to the COVID-19 pandemic.

How Much Advanced Payment Can I Request

Providers can request up to three months of advance Medicare payments. Providers must state their current monthly Medicare billing amount on the request form.  However, some healthcare providers, such as critical access hospitals, inpatient acute care hospitals, children’s hospitals and certain cancer hospitals (collectively, “Other Providers”), may request additional amounts, over longer periods of time.  

When to Expect Payment

According to CMS, MACs are already accepting and processing request forms, and payments will be issued within seven calendar days of receiving the request form.  If the MAC denies the request, there is no appeals process.

Repayment and Recoupment

The recoupment process for advanced payments for most healthcare providers begins 120 days after the date on which the MAC makes the advanced payments (the “Grace Period”).  Providers will continue to receive payment in full during the Grace Period .  Following the Grace Period, the MAC will recoup the advanced payments by offsetting payments otherwise owed to the provider.  

For a small subset of Medicare Part A providers receiving Period Interim Payments, and Other Providers, there are lengthier repayment periods.  For all other healthcare providers, the entire balance of advanced payments must be repaid or recouped within 210 days after the date the MAC makes the advanced payments.  It is likely that interest will accrue (at the rates applicable to Medicare overpayments) for advance payments outstanding after the 210-day repayment period, though CMS has not yet clarified this.

Additional Resources

CMS has published a fact sheet on the advance payment process, which is available here.  Each MAC has established COVID-19 hotlines to assist providers with advance payment requests.  Noridian’s COVID-19 Hotline number is: 866-575-4067.  For additional information about CMS’s Accelerated and Advance Payment Program, please contact Miranda Preston at Miranda@milliganlawless.com, or another health care attorney at Milligan Lawless.