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Financial Relief During COVID-19

Financial Relief During COVID-19

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The COVID-19 pandemic has had an immense impact on Washington state’s physician practices and clinics. Many practices are still reeling from the economic fallout from suspending elective and non-emergent procedures, the costs of transitioning to telehealth, and the loss of revenue as patients stayed home or avoided needed appointments from fear of the virus. Federal funding has helped to offset some of these costs, but to a limited degree—and for medical practices, that funding will no longer be available unless Congress acts.

Washington’s medical practices and clinics are an essential part of the state’s health care ecosystem, serving both urban and rural communities and connecting patients directly with their physicians and care providers. The WSMA will continued to advocate for the health of our state’s practice environment, which directly impacts the ability of patients to receive needed, timely care for themselves and their loved ones.

Independent Practices Face Fallout from Omicron Surge

Results from recent WSMA practice impact survey

Results from a new survey make clear that the rapid rise and spread of the omicron variant adversely impacted independent physician practices across Washington, limiting access to primary and specialty care in communities across the state. Learn more.

Previous practice impact surveys

COVID-19 Practice Economic Impact Survey – October 2020

COVID-19 Practice Economic Impact Survey – April 2020

Financial Assistance Measures

Washington practices get $11 million in latest provider relief distribution

The U.S. Department of Health and Human Services announced $560 million in new Provider Relief Fund Phase 4 payments targeting medical practices and suppliers. The disbursement includes 68 Washington practitioners who will receive $11,428,573. These payments come on the heels of the more than $2 billion released by HHS in January 2022 and nearly $9 billion in funding released in December 2021, which together included nearly $268 million in payments to Washington state. Factoring in the new payments, 1,522 Washington state practitioners are receiving a total of $278,349,863 through Phase 4. Like the earlier Phase 4 payments, the newly announced monies will be based on changes in operating revenue and expenses between Jul. 1, 2020 and Mar. 31, 2021, due to COVID-19 and will be made to physicians who previously applied for relief funds. Visit the HRSA Provider Relief Fund dedicated webpages for more information.

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 (March 20, 2020)

WSMA Practice Viability Advocacy

WSMA survey shows financial impact of COVID-19 on practices

The coronavirus pandemic is hitting physician practices acutely, in terms of both economic hardship and disruption to patient care. Since March 1, almost 100% (99.4%) of independent physician practices report a decrease in patient volume, resulting in millions of dollars in lost revenue. Our survey was shared with 5,000 physicians working in independent (non-networked) physician clinics in Washington state. Learn more

Practice viability graphics

Based on our economic survey of independent practices in Washington, the WSMA created the following graphics for use on social media and other digital communications.

Economic Survey Graphic 1

Economic Survey Graphic 2

Economic Survey Graphic 3

Economic Survey Graphic 4
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