Many of you may have received deposits this past week from the Department of Health & Human Services and if you have not you may this week. These payments apply to Medicare Part B billings only. Below is an outline of what this program entails.
The President signed the bipartisan CARES legislation that provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. Recognizing the importance of delivering funds in a fast and transparent manner, the Department of Health and Human Services (HHS) is distributing $30 billion of the relief funds immediately. These are payments to healthcare providers, not loans, and will not need to be repaid.
Who is eligible for funds from the initial $30 billion?
Billing entities who received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.
If your organization qualifies and you will automatically receive payment soon.
If your business operations ceased as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.
How are payment amounts determined?
Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.
- A provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000, and multiply that ratio by $30,000,000,000. Providers can obtain their 2019 Medicare FFS billings from their organization’s revenue management system.
- As an example: A community hospital billed Medicare FFS $121 million in 2019. To determine how much they would receive, use this equation:
$121,000,000 / $484,000,000,000 x $30,000,000,000 = $7,500,000
How will payments be distributed?
HHS is partnering with UnitedHealth Group to deliver funds. You will receive payment within two weeks via Automated Clearing House (ACH) to the Medicare routing number and account number you have on file with HHS. The automatic payments will come via Optum Bank with â€œHHSPAYMENTâ€ as the payment description. Payments to practices that are part of larger medical groups will be sent to the groupâ€™s central billing office. All relief payments are made to provider billing organizations based on their Taxpayer Identification Numbers (TINs).
What action should I take?
Within 30 days of receiving the payment, you must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. Terms and conditions can be found on hhs.gov/providerrelief. Should you choose to reject the funds, you must also complete the attestation to indicate this. The Payment Portal will guide you through the attestation process to accept or reject the funds. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions.
UPDATE: The CARES Act Provider Relief Fund Payment Attestation Portal is now open. Providers who have been allocated a payment from the initial $30 billion general distribution must sign an attestation confirming receipt of the funds and agree to the terms and conditions within 30 days of payment.
What conditions are there?
As a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
What is going to happen to the remaining 70 Billion?
The Administration is working rapidly on targeted distributions that will focus on providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans.
Whom can I contact for more information?
For additional information, please visit hhs.gov/providerrelief or call the CARES Provider Relief line at (866) 569-3522.