CMS fact sheet outlines request process for advanced and accelerated payments during COVID-19 pandemic

Hospitals may now apply for accelerated and advanced Medicare payments to offset the impact of the novel coronavirus (COVID-19) pandemic. As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, CMS is expanding its Accelerated and Advance Payment Program to more provider organizations and suppliers.

CMS outlined the eligibility criteria and request process in a fact sheet released March 28. Payments made through this program are essentially advance payments on future Medicare billing and are intended to ease cash flow concerns and potential claims filing delays.

To be eligible for accelerated or advanced Medicare payments, organizations must:

• Have billed Medicare within 180 days prior to the date the organization signed the request form
• Not be bankrupt
• Not be under active medical review or program integrity investigation
• Not have any outstanding delinquent Medicare overpayments

Request forms are maintained by and submitted to individual Medicare Administrative Contractors (MAC). The forms will be available on your MAC’s website and may be submitted via email or mail. Organizations should contact their MAC for specific instructions on how to fill out and submit the request.

Organizations must request a specific amount of accelerated or advanced payment. In general, most organizations may request up to 100% of their Medicare payment amount for a three-month period. Certain organizations are able to request accelerated or advanced payment for a longer period of time or a higher percentage of their Medicare payment amount. Inpatient acute care hospitals, children’s hospitals, and some cancer hospitals may request up to 100% of their Medicare payment amount for a six-month period. Critical access hospitals (CAH) may request up to 125% of their Medicare payment amount for a six-month period.

Only completed request forms can be processed. The form must include the organization’s:

• Correspondence address
• Legal business name/Legal name
• National Provider Identifier
• Other information as determined by the MAC

For the reason for request, organizations should check box two (delay in provider/supplier billing process of an isolate temporary nature beyond the provider’s/supplier’s normal billing cycle and not attributable to other third-party payers or private patients). Organizations must also state the request is for an accelerated or advanced payment due to the COVID-19 pandemic. The form must be signed by an authorized representative of the organization.

MACs are expected to review requests and issue payments within seven calendar days.

Accelerated or advanced payments must be repaid. Currently, repayment will begin 120 days after the payment is issued. Inpatient acute care hospitals, children’s hospitals, some cancer hospitals, and CAHs have up to one year to repay the balance. All other Part A providers and Part B suppliers have 210 days to repay the balance.

Organizations must continue to submit claims after the accelerated or advanced payment is issued. Once the repayment period begins, all new claims are used to offset the balance. This means that instead of receiving payment for a newly submitted claim, the organization’s outstanding balance is automatically reduced by that claim payment amount.

At the end of the repayment period the MACs will perform a manual check to determine if a balance remains. If a balance does remain, the MAC will request the organization repay it by direct payment.