Medicare Accelerated and Advance Payment
By Matthew Bavolack, Principal, Advisory Services & Donna Zoellick, Director, Advisory Services
In order to provide additional cash flow to providers and suppliers during the Coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) has expanded the Accelerated and Advance Payment Program to additional Part A and Part B providers. This expansion program will only be in affect during this public health emergency. CMS has streamlined the application process in order to expedite cash flow.
What is the Accelerated and Advance Payment Program?
An accelerated or advance payment is intended to provide necessary funds to providers or suppliers when there is an interruption in claim submission or processing. These payments can also be authorized by CMS during a national public health emergency, which is the case now. Providers or suppliers must submit a request to their Medicare Administrative Contractor (MAC) to receive an accelerated or advance payment. Please note that this program does not apply to Medicare Part C or Part D.
Who is eligible for the program?
You are eligible for this program during this health emergency if you have met the following:
- Have billed Medicare for claims within the previous 180 days
- Are not in bankruptcy
- Are not under an active medical review or program integrity investigation
- Do not have any outstanding Medicare overpayments
How much is available from this program?
Most providers and suppliers will be able to request up to 100% of their Medicare payment amount for a three month period. Acute care hospitals, children’s hospitals and certain cancer hospitals requests may be up to 100% of their Medicare payment amount for a six month period, and critical access hospitals can request up to 125% of their payment amount for a six month period.
How to request to be part of this program?
Go to your MAC’s website to obtain their required forms. Although the forms are similar, each MAC does have its own version.
- CMS has provided MACs with reimbursement reports for the period 10/1/2019-12/31/2019, reflecting the maximum amount that can be paid to a provider. As a result, a facility does not need to pull historical data to support their request. Contact your MAC to obtain this 3 month net reimbursement figure.
- In the financial section of the request form, simply enter “COVID-19 Related”.
When will payment be issued?
Once your request is approved, the MAC will issue payment within seven days.
How will the funds be repaid to Medicare?
Repayment of the funds received will begin 120 days after the date of payment issuance. Acute care hospitals, children’s hospitals, certain cancer hospitals and critical access hospitals will have up to one year from the date of payment to repay the amount received. All other Part A and Part B providers will have 210 days to repay their amounts received.
Providers should continue to submit their claims to Medicare, and full payments will be issued during the 120 day period. At the end of the 120 days, recoupment will begin and all claims submitted will be offset to repay the accelerated payments received. This process will by automatic by the Medicare claim processing system. If there is a remaining balance after the payback period noted above, your MAC will send a letter requesting payment for the remaining balance.
If you would like flexibility in this recovery schedule, contact your MAC with your proposal for repayment.
If you have any questions about the application process for this payment program, please reach out to your Marcum healthcare professional.
Coronavirus Resource Center
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