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Providers need to meet terms to get emergency CMS payments

The Centers for Medicare and Medicaid Services (CMS) has allowed Medicare providers to get emergency assistance payments to help maintain financial stability during the coronavirus pandemic. Upon the agency’s first announcement of this change, the administration stated the payments would be provided with “no strings attached.”

Apparently, that is not the case.

Surprise! Providers must meet these four terms to get the payments

National Association for Home Care & Hospice President William A. Dombi clarifies the payments are “not repayable emergency funds” but that the agency will hold providers accountable for the funds by connecting them to “direct and indirect COVID-19 costs, as well as lost revenue.”

It appears providers must establish this “connection” by meeting the following terms:

  • Previous Medicare fee-for-service reimbursements. In order to receive these funds, the provider must be able to establish they received fee-for-service reimbursements from Medicare last year.
  • No additional expenses as out-of-network provider. The agency also states providers cannot ask for payment from COVID-19 patients that is above the amount the patient would need to pay if an in-network provider provided the care.
  • Coronavirus specific payments. Although providers do not need to treat COVID-19 patients to qualify to receive funding, the agency requires the providers use the payments to cover COVID-19 related expense. This includes “lost revenue” attributable to coronavirus.
  • Documentation. The agency also requires the provider document how it uses the funds.

Why does this matter? The CMS could call on a provider to return all or a portion of the funds if these terms are not met. As a result, it is important for providers to document the need for and use of the funding. Providers should also keep paperwork to support the claim in case the agency requires additional information to support the payments in the future.