Financial relief news in brief (Dec. 11)
CMS Delays EPCS Mandate Until Jan. 2022
The SUPPORT Act, passed by Congress in 2018 to address the opioid epidemic, requires electronic prescribing of controlled substances
for the Medicare Part D Prescription Drug Program starting Jan. 1, 2021. In the final Medicare Physician fee schedule, CMS delayed the
effective date of this requirement until Jan. 1, 2022. The WSMA submitted a letter to CMS in September, urging the agency to delay the
mandate for at least one year due to the financial impact the COVID-19 public health emergency has had on physician practices. We are
pleased to see CMS adopt this request.
Financial relief news in brief (Oct. 8)
Financial relief news in brief (Aug. 3)
Financial relief news in brief (July 10, 2020)
$15 billion Is being distributed to Medicaid providers. Has your practice received its share?
The Washington State Health Care Authority has raised concerns with HHS about its recent Medicaid distribution, asserting the funds
allotted are insufficient and that it's administratively burdensome for practices to tap into. Perhaps most concerningly, practices
were not aware that accepting the Medicare general distribution would preclude them from receiving Medicaid funds.
Learn more. (June 30, 2020)
Financial relief news in brief (June 25, 2020)
HHS updates FAQs on the Provider Relief Fund general distribution (May 29, 2020)
U.S. Department of Health & Human Services has updated its
frequently asked questions document regarding the CARES Act Provider Relief Fund. Several of the FAQs dated May 14 seek to clarify some of the recent confusion around the general distribution, particularly these
two questions:
How did HHS determine the additional payments under the general distribution?
HHS is distributing an additional $20 billion of the general distribution to providers to augment their initial allocation so that $50
billion is allocated proportional to providers' share of 2018 net patient revenue. The allocation methodology is designed to provide
relief to providers, who bill Medicare fee-for-service, with at least 2% of that provider's net patient revenue regardless of the
provider's payer mix. Payments are determined based on the lesser of 2% of a provider's 2018 (or most recent complete tax year) net
patient revenue or the sum of incurred losses for March and April. If the initial general distribution payment you received between
April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you will not receive additional general
distribution payments.
How can I estimate 2% of patient revenue to determine my approximate general distribution payment?
In general, providers can estimate payments from the general distribution of approximately 2% of 2018 (or most recent complete tax
year) patient revenue. To estimate your payment, use this equation:
- (Individual Provider Revenues/$2.5 Trillion) X $50 Billion = Expected Combined General Distribution.
-
To estimate your payment, you may need to use "Gross Receipts or Sales" or "Program Service Revenue." Providers should work with a
tax professional for accurate submission.
This includes any payments under the first $30 billion general distribution as well as under the $20 billion general distribution
allocations. Providers may not receive a second distribution payment if the provider received a first distribution payment of equal to
or more than 2% of patient revenue.
Download the FAQ (modified May 29,2020).
Financial relief news in brief (May 29, 2020)
CMS reevaluates Accelerated Payment Program and suspends Advance Payment Program
The Centers for Medicare & Medicaid Services announced that it is reevaluating the amounts that will be paid under its Accelerated
Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately.
CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning
stages of the 2019 Novel Coronavirus (COVID-19). Unlike other funding programs, the advance and accelerated payments were not grants
and had to be paid back within one year or less, depending on provider type.
Funding will continue to be available to physicians and providers through the
Provider Relief Fund, and these payments do not
need to be repaid. Click here for more
information on the CARES Act Provider Relief Fund and how to apply, visit this website. For an updated fact sheet on the Accelerated
and Advance Payment Programs,
click here. (April 27, 2020)
Updates on new PPP funding, additional HHS provider relief funds, and more
Congress passed The Paycheck Protection Program and Health Care Enhancement Act, injecting $321 billion of new funding into the small
business loan program and allocating additional funding to assist the COVID-19 response. Also this week, the U.S. Department of Health
& Human Services announced more funds from the $100 billion CARES Act Provider Relief Fund will be released starting this week.
Learn more about these federal relief efforts. (April 24, 2020)
FCC offers financial support for telehealth services
The Federal Communications Commission offers new programs for physicians and other providers aimed at assisting with your telehealth
program setup and enhancing capacity.
Learn more.
HHS announces immediate infusion of $30 billion into health care system
To support health care-related expenses or lost revenue attributable to COVID-19, the federal government is distributing $30 billion
immediately—with payments arriving via direct deposit beginning April 10, 2020—to eligible providers throughout the
American health care system. These are payments, not loans, to health care providers, and will not need to be repaid.
Learn more. (April 10, 2020)
CMS issues new guidance on advance payments
The Centers for Medicare & Medicaid Services provides information on how physicians can request accelerated and advance payments.
The agency clarifies that it will prioritize assistance to those states hardest hit by COVID-19, including Washington. Additionally,
CMS provides coding guidance for testing and claims reporting. Download
CMS Letter to Clinicians to Summarize Actions CMS Has Taken to Ensure Clinicians Have Maximum Flexibility to Reduce Unnecessary
Barriers to Providing Patient Care.(April 7, 2020)
Insurers announce accelerated, advance payment programs
UnitedHealth Group has announced a new accelerated payment program to pay claims faster, helping physician practices that are being
impacted by COVID-19. Accelerated claim payments will be available to medical and behavioral care providers in UnitedHealthcare's fully
insured commercial, Medicare Advantage, and Medicaid businesses. UHG is also suspending prior authorization requirements in some
settings to assist patients and providers. Read the
UnitedHealth Group announcement
for details. Premera Blue Cross has also announced it's providing up to $100 million in financial support in the form of advance
payments of claims to medical, dental, and behavioral health providers facing significant financial pressures due to the COVID-19
pandemic. Premera is also extending prior authorization timeframes in light of the non-urgent medical procedure delay order. Learn more
about Premera's advance payment program and related policies on its
website. (April 9, 2020)
Financial relief news and resources in brief
Physician practices qualify for federal small business loan program
A recent WSMA survey of physician clinics in our state found that virtually all respondents are being financially impacted by COVID-19,
with several having to close their doors altogether. The federal stimulus package (a.k.a. CARES Act) is intended to provide financial
relief to individuals and businesses through a number of programs. The "Paycheck Protection Program"
is likely to be of most utility to physician practices, as it provides loans of up to $10 million to qualifying businesses of less than
500 employees that under some circumstances do not need to be repaid.
Intended primarily as a tool for businesses impacted by COVID-19 to cover payroll costs as well as some operational expenses, the PPP
loans do not require collateral and can cover up to two months of your average monthly payroll costs from the last year, plus an
additional 25% of that amount (with payroll calculations capped at $100,000 per employee). Provided that the funds are used to
primarily cover payroll costs, and that staff and payroll are maintained for the duration of the loan, the loan can be forgiven. Beyond
payroll, up to 25% of the loan may be used for operational expenses such as rent, interest on mortgages, and utilities.
The PPP launches on Friday, April 3, and given the projected demand for loans, early participation is strongly encouraged. As a first
step, consider reaching out to the bank your practice works with as all federally-insured financial institutions are eligible lenders.
A fact sheet on the program from the Treasury Department can be found here, and the
application form can be found here.
Other financial assistance during COVID-19
The US Small Business Administration is offering a low-interest loans to help small business owners meet financial obligations, cover
operating expenses, and alleviate economic injury caused by COVID-19.
Click here to determine your eligibility. For
more information and to apply, click here. For questions,
800.659.2955 or disastercustomerservice@sba.gov. (March 20, 2020)