<img src="//bat.bing.com/action/0?ti=5163419&amp;Ver=2" height="0" width="0" style="display:none; visibility: hidden;">

Nextech Blog

CMS Authorizes Medicare Advanced Payment Program

Posted On 04/21/2020 by Courtney Tesvich

IMPORTANT NOTICE: As of April 26, 2020, CMS has suspended the Advanced Payment Program, effective immediately, and is reevaluating the Accelerated Payment Program.

CMS Press Release on Program Suspension


The current COVID-19 pandemic has impacted specialty practices across the country and around the world, resulting in low patient volumes and decreased revenues. As part of the CARES Act, the Centers for Medicare & Medicaid Services (CMS) authorized relief to providers in the form of Advanced Medicare Payments. However, it is important for providers to note that this Advance Payment Program is an interest free loan, not a grant.

This program allows ambulatory physicians to request up to 100% of their Medicare payment amount for a 3-month period. Physicians can take advantage of this program by submitting an application through their MAC and requesting a specific amount (it does not have to be 100% of your 3-month average). Maximum allowed payments will be calculated using the past amounts paid out for the October-December 2019 period.

Applications must be submitted through a provider’s designated MAC. For providers who may be unfamiliar with their MAC, you can easily locate the appropriate contractor using this link.

To request advanced payments, the following information will need to be provided (so be sure to have it on all hand):

  • Provider Identification Information
  • Legal Business Name/Legal Name
  • Correspondence Address
  • National Provider Identifier (NPI)
  • Other Information as Required by the MAC
  • Amount to Request Based on Need
  • Reason for Request

Once your request is made and approved, you will receive your advance payment within seven calendar days.

Repayment of the zero-interest loan will begin 120 days after the payment is issued and will be collected over a period of up to 210 days after the initial payment was made. During the 120 days prior to the beginning of the repayment period, the provider can continue to submit Medicare claims as normal and no repayment will be made. At the end of the 120-day period, every claim submitted by the provider will be offset to repay the remaining balance of the advanced payment loan. The full amount of any claims submitted during this time period will be withheld until the outstanding amount of the advanced payment is repaid. This process is automatic—payment attribution to the balance will begin on day 120.  Remittance advice during the repayment period will reflect the fact that the claims have been reduced to repay the advance payment loan.

If there is a remaining balance at the end of the 210-day repayment period, the MAC will send a request for payment to the provider. If the practice is unable to pay the balance at that time, they can request an extended repayment plan from the MAC. Providers will be charged 10.25% interest on extended repayment plans.

In these uncertain times, specialty practices need to consider every possible means of generating temporary revenue. For some providers, the CMS advance payment program offers a possible way to keep their practices afloat until patient volume returns to normal. However, providers should always consider all of their options and make the decision that is best for them and their practices. Stay tuned to this blog for continuing updates on new regulatory changes and other important information.


DISCLAIMER

The information provided in this blog article does not, and is not intended to, constitute legal or other advice; instead, all information, content, and materials are available for general informational purposes only. Information in this article may not constitute the most up-to-date legal, financial or other information. Readers should contact their attorney, financial, tax, or other advisor to obtain advice with respect to any particular matter. This article contains links to other third-party websites. Any such links are provided only for convenience and Nextech does not recommend or endorse the contents of any third-party sites.

Topics Compliance, COVID-19

Courtney Tesvich

Courtney Tesvich serves as Nextech's VP of Regulatory and Compliance.