CMS Accelerated Payment Program
What You Need to Know, How to Apply, and How Encoda Helps
Purpose of CMS Accelerated & Advanced Payment Program:
- Increase cash flow to providers impacted by COVID-19
- Advanced payment is intended to provide funds during a disruption in claims submission/processing
- The program expansion is only for the duration of this current public health emergency.
- CMS is providing the advanced payment to any Medicare provider who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the required qualifications.
Who is eligible?
- All Medicare providers and suppliers, including physicians and other Part B suppliers, acute care, critical access, and other types of hospitals and skilled nursing facilities
What’s the criteria?
- In order to qualify for advance payments, the provider must:
- Have billed Medicare within 180 days immediately prior request
- Not be in bankruptcy
- Not be under medical review/program integrity investigation
- Not have outstanding delinquent Medicare over payments
Amount of payment:
- You must request a specific amount to be paid using the “Accelerated or Advance Payment Request” form provided on each MAC’s website
- Providers can request up to 100% of their historical Medicare payment amount for a 3-month period
- MACs will review and issue payments typically within 7 calendar days of receiving the request
- Repayment begins 120 days after issuance of the advance payment
- Providers will have 210 days from the date of advanced payment to repay the balance (thus you’ll have a 90-day window for repayment).
Recoupment and reconciliation:
- Providers continue to submit claims after the issuance of the advance payment and will continue to receive full payment on claims for 120 days
- Recoupment process will begin at the end of the 120-day period
- Every new claim submitted thereafter by the provider (for the subsequent 90 days) will be offset with a $0.00 payment until the balance of the advanced payment is paid.
- Instead of receiving payment for newly submitted claims, the provider’s outstanding advance payment balance will be reduced by what would otherwise have been a payment
- This 100% Medicare withhold is automatic during the 90-day repayment period
- Providers will have 210 days from the date of the advanced payment to repay the balance. MACs will send a request for bulk repayment for any remaining balance at the end of the 210 days.
If you have Encoda BackOffice, you can track advanced payment recoupments once they begin, reconcile against new claims, and keep you informed of your advanced payment balance.
- Encoda BackOffice will automatically:
- Reconcile recoupments against the advanced payment balance
- Provide comprehensive reporting of each check that includes recoupments
- Provide line item detail for each recoupment check
- Provide remaining balance for the advanced payment
How to apply:
- Locate the appropriate form on your respective MAC’s website. Forms do vary. Click here to download a PDF containing a list of MACS and links directly to each MAC’s Accelerated Payment Application.
- Complete form and submit to your servicing MAC via online submission, email, or mail as applicable
- CMS has established COVID-19 hotlines at each MAC that are operational Mon-Fri to assist with advanced payment requests
- Click here to access links to the various MAC application websites.
What to include on the request form:
- Provider identification information such as legal business name, address, and NPI
- Amount requested based on your need. You may request up to 100% of Medicare payments for 3-months
- Reason for request. Check box #2: “Delay in provider billing process of an isolated temporary nature beyond the provider’s normal billing cycle and not attributable to other third-party payers or private patients”. State that the request is for an accelerated/advance payment due to COVID-19 pandemic.
- The form must be signed by an authorized representative of the provider
What review does the MAC perform:
- The MAC will perform a validation of the following eligibility criteria:
- Has provider billed Medicare within 180 days immediately prior to the request?
- Is the provider in bankruptcy?
- Is the provider under medical review or program integrity investigation?
- Does the provider have outstanding delinquent Medicare over payments?
When you should expect payment:
- The MAC will notify the provider as to whether the request is approved or denied via email or mail (based on the provider’s preference)
- If approved, payment will be issued by the MAC within 7 calendar days from the request
Do providers have appeal rights?
- Providers do not have administrative appeal rights related to these payments.
- However, administrative appeal rights would apply to the extent CMS issued overpayment determinations to recover any unpaid balances on advanced payment
Need help with your application or want to see a demo of Encoda BackOffice? Call us at 813.337.0107 x3 or click here contact us.