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COVID-19: CMS Advances Payments to Providers and Suppliers

March 29, 2020

In order to increase cash flow to providers and suppliers during this public health emergency, CMS is expanding the current Accelerated and Advance Payment (“AAP”) program to a broader group of Medicare Part A providers and Part B suppliers.

Accelerated/Advance Payment Program

The AAP provides necessary funds to providers and suppliers to accelerate cash flow when there: (i) is a disruption in claims submission and/or claims processing; and (ii) a national emergency or disaster.  During this public health emergency, CMS will provide such accelerated or advance payments to any Medicare provider/supplier who submits a request to their Medicare Administrative Contractor (“MAC”) and meets the required qualifications.

Eligibility & Process

To qualify for AAP, 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.

Amount of Payment

Providers/Suppliers will be asked to request a specific amount using an AAP Request form which can be found 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.  Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100% of the Medicare payment amount for a six-month period.  Critical access hospitals can request up to 125% of their payment amount for a six-month period.

Processing Time

Each MAC will work to review and issue payments within seven (7) calendar days of receiving the request.

Repayment, Recoupment and Reconciliation

At the end of the 120-day period, the recoupment process will begin and every claim submitted by the provider/supplier will be offset from the new claims to repay the AAP.  Instead of receiving payment for newly submitted claims, the provider’s/supplier’s outstanding AAP balance is automatically reduced by the claim payment amount.  

The majority of hospitals including inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals will have up to one year from the date the accelerated payment was made to repay the balance.  One year from the accelerated payment, the MACs will perform a manual check to determine if there is a balance remaining, and if so, send a request for repayment of the remaining balance.  All other Part A providers not listed above and Part B suppliers will have up to 210 days for the reconciliation process to begin.

For the small subset of Part A providers who receive Period Interim Payment, the accelerated payment reconciliation process will happen at the final cost report process (180 days after the fiscal year closes).

More information on this process will also be available on your MAC’s website and here.

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