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3 things providers need to know to get expedited CMS payments

The United States Centers for Medicare and Medicaid Services (CMS) recently announced expansion to its accelerated and advanced payment program. The agency states the changes are intended to help providers who receive payment from Medicare to get the funds they need while battling the 2019 Novel Coronavirus (COVID-19).

How can the agency make this change?

In the past, the agency has been able to provide these payments during hurricanes and other natural disasters. According to the CMS, the recently passed the Coronavirus Aid Relief and Economic Security (CARES) Act allows the agency to expand this ability to provide medical practitioners payment to the current public health emergency created by COVID-19.

How do these payments work?

The agency's announcement means it will offer expedited payments to Medicare providers throughout the country. The amount available varies. Most hospitals, doctors and other medical care providers can request payments for a three-month period. Other facilities, like acute care hospitals, children's hospitals and some cancer centers can receive payment for a longer period. At this time, that amount is set to equal the payments requested for a six-month period. The agency has also agreed to allow critical access hospitals up to 125% of previous payment amounts for a six-month period.

To qualify, the agency will consider the following:

  • Billing history. The provider must have billed Medicare within 180 days prior to the request.
  • Good standing. The provider must not be in bankruptcy, under active medical review or a program integrity investigation.
  • No overpayments. The agency will also likely deny any request from a provider with an outstanding delinquent Medicare overpayment.

As is true during other emergency payment periods, the CMS will expect repayment. In this case, the agency extended the repayment period to 210 days for most providers. Inpatient acute care hospitals, children's hospitals, cancer centers and critical access hospitals will have up to one year. The agency states that once it receives a request for an expedited payment, it should be able to send the payment to the provider within seven days.

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