Summary of Financial Relief Provisions Under the CARES Act

AAA Operations & Human Resources Consultant Scott Moore, Esq has developed a summary of financial relief provisions from the recent CARES Act. The resource will help your organization evaluate in which programs it may qualify to participate. Download the CARES Act Financial Relief Comparison Download the Paycheck Protection Program Calculator...

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EMS Agencies Can Take Advantage of Accelerated or Advanced Payment Opportunities from CMS

The Centers for Medicare and Medicaid Services (CMS) has expanded the Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers in an effort to provide financial relief and to increase cash flow to providers of services and suppliers impacted by the 2019 Novel Coronavirus (COVID-19) pandemic. To be eligible to participate in the Accelerated and Advanced Payment Program, providers and suppliers must meet the following criteria: Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form; Not be in bankruptcy; Not be under active medical review or program integrity investigation; and Not have any outstanding delinquent Medicare overpayments. Qualified providers and supplies will be asked to request a specific amount using an Accelerated or Advance Payment Request form provided on each MAC’s website. Generally, most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period.  Payment is typically processed in about seven (7) days.  Ambulance providers and suppliers can utilize these accelerated or advanced payments to ease cash flow disruptions during the COVID-19 public health emergency.  To access these payments, select...

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CMS “Pauses” Prior Authorization Model for Scheduled, Repetitive Non-Emergency Ambulance Transportation

CMS released published a guidance document summarizing some of the steps that it has taken to relieve the administrative burden on health care providers and suppliers during the current public health emergency.  As part of that document, CMS indicated that it will be “pausing” the Prior Authorization Model for scheduled, repetitive non-emergency ambulance transports.  Under this program, ambulance suppliers are required to seek and obtain prior authorization for the transportation of repetitive patients beyond the third round-trip in a 30-day period.  Absent prior authorization, claims will be stopped for pre-payment review.  The Prior Authorization Model is currently in place in Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, West Virginia, and the District of Columbia. CMS indicated that this pause went into effect as of March 29, 2020, and will continue for as long as the current public health emergency continues.  During this pause, claims for repetitive, scheduled, non-emergency transports will not be stopped for pre-payment review if the prior authorization has not been requested and obtained prior to the fourth round-trip.  However, CMS indicated that claims submitted and paid during the pause without prior authorization will be subject to postpayment review. CMS further indicated that during this...

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Accelerated Payment Program Highlights

CMS announced at the end of last week that it is expanding its Accelerated Payment Program.  The goal of the program is to address cash flow problems arising from the public health emergency.  The program functions as a short-term loan with no interest. To qualify for advance/accelerated payments the provider/supplier must: (1) Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form; (2) Not be in bankruptcy; (3) Not be under active medical review or program integrity investigation; and (4) Not have any outstanding delinquent Medicare overpayments. Qualified providers/suppliers will be asked to request a specific amount using an Accelerated or Advance Payment Request form provided on each MAC’s website. Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period. All non-hospital Part A providers and Part B suppliers will have 210 days from the date of the accelerated or advance payment was made to repay the balance. The provider/supplier can continue to submit claims as usual after the issuance of the accelerated or advance payment; however, recoupment will not begin for 120 days. Providers/ suppliers will receive full payments for...

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Trump Administration Provides Financial Relief for Medicare Providers

FOR IMMEDIATE RELEASE March 28, 2020 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries Trump Administration Provides Financial Relief for Medicare Providers Action comes to aid providers and suppliers facing challenges in responding to COVID-19 pandemic Under the President’s leadership, the Centers for Medicare & Medicaid Services (CMS) is announcing an expansion of its accelerated and advance payment program for Medicare participating health care providers and suppliers, to ensure they have the resources needed to combat the 2019 Novel Coronavirus (COVID-19). This program expansion, which includes changes from the recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act, is one way that CMS is working to lessen the financial hardships of providers facing extraordinary challenges related to the COVID-19 pandemic, and ensures the nation’s providers can focus on patient care. There has been significant disruption to the healthcare industry, with providers being asked to delay non-essential surgeries and procedures, other healthcare staff unable to work due to childcare demands, and disruption to billing, among the challenges related to the pandemic. “With our nation’s health care providers on the front lines in the fight against COVID-19, dollars and cents shouldn’t be adding to their worries,” said CMS Administrator Seema (more…)

Webinar Materials & FAQ: Claims Guidance for COVID-19

Webinar: How to Best Document and Track Claims Related to COVID-19 Recorded: Thursday, March 26th | 12:00pm Eastern View On-Demand Recording View PPT Slides FAQ of unanswered webinar questions: Is the idea that the ET3 model will be pushed to all ambulance companies or only previously selected participants? The request into CMS and leadership during the declared public health emergency is to allow all ambulance providers and suppliers to transport patients or treat in place based upon the concepts outlined in the Emergency Triage, Treatment and Transport model as defined by CMMI’s release last year. While we wait for finalization of the ET3 protocols, will billing be allowed retroactively? If CMS follows other waiver provisions that they have been approving, then we would expect the waiver to be retroactive. However, that will be clearly identified when and if the final waiver is approved. Asbel spoke about Telehealth medical necessity, which we assume applies to the QHP.  Neither CMS nor the MAC has provided any guidance regarding MN guidance for the ambulance that is facilitating the telehealth.  CMS ET3 FAQ provides a non-answer. Can you advise? You will need to understand the nuances around telehealth and what Medicare requires as a (more…)