T he COVID-19 outbreak has disrupted the healthcare industry in unprecedented ways. The global pandemic has affected a broad spectrum of the healthcare ecosystem including the patients, providers, pharma industry among the others. While the healthcare continuum is working together to fix the broken pieces, it is undeniable that the financial ramifications have also been quite significant on the health systems. Kaiser Family Foundation report indicates that Hospital healthcare reimbursement for uninsured COVID-19 patients could account for over 40% of the $100 billion allocated by the Trump administration for the Coronavirus package. The federal government has pulled back the curtain on telehealth services, relaxed specific policies, and expanded Medicare and Medicaid benefits to help fight the global crisis. However, beneficiaries are uncertain around patient responsibilities, claims, reimbursement and more, leaving them baffled around the situation. This blog aims to shed light on some of the key concerns around healthcare reimbursements, eligibility, responsibilities and a whole lot more — in the wake of COVID-19.

To begin with, here goes the good news to providers.

Centers for Medicare and Medicaid Services (CMS) has announced an upfront healthcare reimbursement or an Accelerated and Advance Payment Program to reduce financial hardships and help Providers better fight the pandemic. . On the heels of the Medicare and Medicaid announcement, even private payer organizations have stepped up to offer advanced claim reimbursements to shoulder the financial burden of providers. Along with upfront reimbursements, payers are also easing prior authorization requirements to facilitate care delivery during these uncertain times.

Providers are postponing non-essential and elective surgeries to increase capacity and resources for COVID-19 care, resulting in significant revenue losses to independent practices and hospitals. To mitigate potential losses, the government rolls out several initiatives as these on the grounds of national emergencies and natural disasters to improve cash flow to health systems and suppliers. This is an expansion of the Coronavirus Aid, Relief and Economic Security (CARES) Act that attempts to relax the financial burdens and help care providers single-mindedly focus on quality care at this crucial time of crisis. However, it comes with a set of eligibility criteria that healthcare providers need to be mindful of.

Eligibility criteria for the Advanced Payment Program

• The Provider or supplier needs to bill for Medicare claims within 180 days
• Provider must not be in bankruptcy
• Should not be under medical review or part of any program integrity investigation
• Must not have outstanding overpayments with Medicare

How to Avail Upfront Healthcare Reimbursements during COVID-19

1. Providers need to login to the Medicare Administrative Contractor’s (MAC) website and submit an Accelerated or Advance Payment Request form.
2. To locate the MAC designated to your geographical area, refer to https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Downloads/MACs-by-State-June-2019.pdf
3. You will get a notification (via email or any other preferred mode of communication) on approval or denial of the request
4. If approved, the payment will be issued within a stipulated time of 7 working days

Providers can request up to 100% of Medicare healthcare reimbursements for a period of three months. Furthermore, Critical Access Hospitals (CAH) can avail up to 125% for an extended period of six months.

To get help with healthcare reimbursements during COVID-19, contact SolvEdge at
+1-(833) 33-Solve / business@solvedge.com

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