AdvantEdge solutions include medical billing, certified coding, analytics, practice management, compliance and ClientFirstTM service.
Beginning on August 1st, providers are expected to start repaying accelerated Medicare loans received for COVID-19 relief. To ensure payments are recouped, providers won’t receive Medicare reimbursement from their claims until the amount of the loan received is reduced to zero. With more than $100 billion in loans given to providers, we outlined what to expect going forward.
Providers are expected to start paying back loans 120 days after CMS issues the payment.
CMS will automatically zero out Medicare fee-for-service payments from any newly submitted claims until the borrowed funds are repaid.
Hospitals will have to repay the full balance of their loan a year after it was issued. Other Medicare Part A providers have a total of 210 days.
Congress has been negotiating loan forgiveness or looser repayment structures in the next round of the COVID-19 relief bill. To stay updated, subscribe to our newsletters
CMS released an updated COVID-19 FAQ on Medicare fee-for-service billing for COVID-19 related services. The policies in the article are effective for the duration of the PHE unless superseded by future legislation. With 41 sections and over 200 questions and answers, we highlighted key information below.
Physician Services
Question: What does the IFC change for physician and practitioner billing?
Answer: With the revision of certain Medicare regulations, the IFC makes temporary changes to certain policies regarding
Supervision by a physician or non-physician practitioner
Payment for certain services furnished by teaching physician and moonlighting residents
Telehealth and other communication technology-based services
Services provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers
(FQHCs)
Payment to laboratories for specimen collection
Question: What are the changes to supervision?
Answer: CMS is revising the definition of direct supervision to include, during the PHE, a virtual presence through the use of interactive telecommunications technology for services paid under the Physician Fee Schedule and hospital outpatient services.
Question: When do the changes on supervision take effect, and for how long?
Answer: The changes to supervision rules are effective for services beginning March 1, 2020, and last for the duration of the COVID-19 Public Health Emergency
Question: Can medical groups contracted to provide care at local hospitals bill Medicare for covered professional services at temporary expansion sites.
Answer: Yes. Practitioners would bill under the Medicare Physician Fee Schedule and following existing billing rules for services furnished in the hospital. Practitioners should add the modifier “CR” to professional claims for patients treated in temporary expansion sites during the PHE.
General Billing Questions
Question: Regarding the use of the condition code “DR” and modifier “CR,” should these codes be used for all billing situations relating to COVID-19 waivers?
Answer: Yes. Except for telehealth services, the use of the “DR” condition code and “CR” modifier is mandatory for institutional and non-institutional providers in billing situations related to COVID-19 for any claim for which Medicare payment is conditioned on the presence of a “formal waiver.”
How is AdvantEdge Healthcare Solutions currently positioned?
First off, I would like to mention that although AdvantEdge Healthcare Solutions has not been spared from the economic uncertainty, we are grateful to be in a position with limited exposure.
Having multiple locations and a history of operating with remote employees allowed us to execute swiftly and thoughtfully during these unprecedented times. With continuous adjustments and refinement of our processes, business model, and technology, we have been able to deliver for our clients with the quality and performance they know and deserve. Allowing AdvantEdge not only to address the challenges of the COVID-19 crisis but also to identify opportunities throughout.
With 85%+ of your employees working from home, how has the experience been for AdvantEdge?
The work from home experience has been great, and what made this such a unique experience was our readiness to transition. We have always had 15% – 20% of our workforce remote, and have been using video conferencing as a normal part of our business for many years, making the “COVID” transition much less intrusive and disruptive than it likely is for most of our competitors.
The heavy-lift was increasing our remote workforce from 20% to 85%, which also has implications on how business may be conducted in the future. We are discovering several functions traditionally done in the office that can transition to a remote environment more easily than expected. We do not subscribe to the general theory that productivity decreases when working from home and have proven that to be incorrect. I believe we will see new and unique business models going forward, across many industries.
With AdvantEdge having global operations, what is the situation like for other countries?
Our visibility into the global environment mainly comes from our 2 locations in India. Much of India has implemented and eased restrictions in manners similar to the United States. In India, like the United States, we have seen protocols around office capacity, facemasks and other PPE, social distancing, and the concept of “essential business.”
The mood has been quite positive; through constant contact with our global team, we discuss techniques to handle workloads and how to properly distribute work based on the ebbs and flows of domestic and international COVID based restrictions, allowing us to provide the best service and solution to our clients. Having our own global operations and not relying on outsourcing to third-party BPOs overseas, who have been incredibly affected by this crisis, has helped us tremendously during this time and will continue to do so.
Do you have any tips for navigating these times?
Have an open line of communication with your team, up and down, environmentally and legislatively, to understand how business is being effected from all aspects.
Stay informed, stay engaged, and continue to do what is right. Actionable data, as opposed to anecdotal information, should be a considerable driver of your decisions. We believe in asking questions early and often and accepting real data, even if it is not what we want to hear. If your team is constructed of amazing individuals, like ours is, you shouldn’t be afraid to lean on them.
You also need to be truthful with yourself relative to the economic effects of this crisis. The healthcare industry felt the financial impact of COVID-19 greatly, and it’s essential to acknowledge and address the reality on the ground, even though it necessitates more difficult [and often unpleasant] decisions and harder work. Build your plan based on financial realities and follow that blueprint to recovery.
What have you learned from this experience?
When the going gets tough, the tough really do get going. I don’t mean this as a self-reflection but a reflection of my team. I am honored to see first-hand how my team responded when faced with this adversity, and I can proudly say their character is unbelievable.
“People are always stronger than you think, and if you have trust in your team, you will be rewarded.”
Throughout all of this, our mission has not changed; improve healthcare outcomes for all people by enabling our clients to have a razor-sharp focus on delivering clinical care within their communities. Eliminate their distractions by making them our competencies. Be a resource and communicate, communicate, communicate. It has been a privilege to be on a team so dedicated and focused.
HHS announced Friday, July 17, it will deliver an additional $10 billion in federal release dollars to hospitals in new COVID-19 hot spots.
Overview
More than 1,000 hospitals will receive funding with the most funding going to Illinois ($740 million), New York ($683.6 million), and Pennsylvania ($654.6 million).
The second round of hot spot funding will reimburse providers who cared for a disproportionately high number of patients with the disease through June 10.
Funding is for hospitals with more than 161 COVID-19 admissions during that period—or one admission per day—or that experienced a disproportionate intensity of COVID-19 admissions. Hospitals will be paid $50,000 per eligible admission (the first round paid $76,795 per eligible admission).
The American Hospital Association informed HHS that more funding is needed as it does not consider areas in the country experiencing the current surge. To stay up-to-date on HHS Funding and COVID-19 news, subscribe to our newsletter here: AdvantEdge Healthcare Solutions Newsletter
Sources: HHS Gov
If you received PPP funds or HHS Relief Funds in excess of $150,000 (per TIN), you are required to file a quarterly report to HHS. The initial quarterly reports would have been due by July 10, 2020. However, HHS delayed the quarterly reporting requirement.
HHS stated it is still working on a report containing all the necessary information required to comply with the reporting requirements. HHS will notify providers that attested to the funds of due dates and reports needed in a few weeks.
As a reminder, information is changing daily, and we do our best to keep articles current. We encourage everyone to subscribe to our newsletters for updates.
Overview
If any TIN receives more than $150,000 in the aggregate from both the Relief Funds and any other stature authorizing funds due to COVID-19 (ex: PPP loans), the entity must submit quarterly reports to HHS and the Pandemic Response Accountability Committee.
President Trump signed the bipartisan Paycheck Protection Flexibility Act (the “Act”), Friday, June 5, 2020. The Act significantly changes the Paycheck Protection Program (“PPP”). Below is a list of the most significant changes made by the Act.
Forgiveness Period
PPP Borrowers can now extend the term during which the PPP funds can be spent from 8 weeks to 24 weeks, or borrowers can keep the original 8-week period within which to spend the PPP funds—allowing borrowers to increase the amount of their loan that can be forgiven.
Payroll Requirement
The Act reduces the percentage of the PPP loan that must be spent on payroll from 75% to 60%. The other 40% can be spent on interest on mortgages, covered rent, and covered utilities.
Restore Workforce Level and Wages
Borrowers now have until December 31 (as opposed to the previous deadline of June 30) to restore their workforce levels and wages to the pre-pandemic levels required for full forgiveness.
New Exceptions to Restoring Workforce
The legislation includes two new exceptions allowing borrowers to achieve full PPP loan forgiveness even if they don’t fully restore their workforce. Previous guidance already allowed borrowers to exclude from those calculations employees who turned down good-faith offers to be rehired. The new Act will enable borrowers to exclude employees because they could not find qualified employees or be unable to restore business operations to February 15, 2020, levels due to COVID-19 related operating restrictions, such as social distancing or other safety requirements related to COVID-19.
Loan Maturity
Repayment of existing PPP loans can be extended up to 5 years (from the current two years) if the lender and borrower agree. The interest rate remains at 1%.
Forgiveness Application
If you do not apply for loan forgiveness within ten months after the last day of your covered period (i.e., your eight weeks or your 24 weeks from the date you received the loan), you must start paying back principal and interest on the loan.
The Breakdown
After choosing the 24 weeks to spend the PPP funds, the maximum amount paid per employee jumps from $15,385 to approximately $45,000, making it likely that the vast majority of the PPP funds will be spent on payroll. Additionally, the forgiveness application will have to change based on the extended time frame to spend the funds and the additional amounts that can be spent on non-payroll expenses.
Sources: SBA Government
What if the Paycheck Protection Loan isn’t enough?
On May 12, 2020, the House proposed a new $3 trillion COVID-19 relief bill. The critical aspects of the bill are outlined below.
One-third of the funding ($1 trillion) would be allocated to the state, local, and territorial governments
Additional direct payments to individuals and families
$1,200 to individual tax filers
$6,000 for joint filers
$1,200 for each dependent child
Extending the $600 weekly unemployment insurance increase until January
Funding hazard pay to essential workers
Funding new testing and contact tracing programs
Increasing employee tax credits for employers from $5,000 per worker to $12,000 per worker, per quarter
$100 billion for primary, secondary, and postsecondary education
Funding federal and state public health programs to improve data collection on racial and ethnic disparities
The House could vote on the bill as early as Friday, May 15, 2020. Although it is not expected to receive any Republican support, elements of the bill could be included in a compromised, bipartisan relief bill that could emerge over the coming weeks.
Provider Name: Provider name associated with the billing TIN to whom the payment was issued.
State: Location of the provider’s state
City: Location of the provider’s city
Payment: The total (cumulative) payment that the provider has received & attested to as of May 4.
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One deadline that hasn’t changed due to COVID-19 is the Pre-Publication Open Payments Review and Dispute, set for May 15, 2020. The national disclosure program promotes transparency and accountability regarding financial relationships between providers and healthcare manufactures and group purchasing organizations (GPOs). The information is available to the public through the Open Payments Search Tool (https://openpaymentsdata.cms.gov/.)
The Open Payments Search Tool is used to search payments made by drug and medical device companies to physicians and teaching hospitals, according to CMS. Under the law, CMS must report payments from these companies to physicians in the prior year by June 30.
Practice representative will be required to log in to the CMS Enterprise Portal (https://portal.cms.gov/wps/portal/unauthportal/home/) to review and dispute Open Payments Dataset and access 60+ other CMS healthcare-based applications. For security purposes, CMS locks accounts that have not been accessed for 60 days and deactivates accounts not accessed in 6 months, so the physician may be required to re-register if the physician’s ID and password have expired. Additional instruction is available on the CMS.gov/openpayments portal.
On April 30th, 2020, CMS finalized an expansion of telehealth services allowing a wider range of care to Medicare beneficiaries in their homes.
Expansion of providers that can conduct telehealth services
Physical therapists, occupational therapists, and speech-language pathologists.
Increase Payment of telehealth visits
Payments will see an increase from a range of about $14-$41 to about $46-$110 for telephone codes 99441-99443.
CMS is broadening the list of services that Medicare would pay for, no including much behavioral health and patient education services.
CMS is waiving the video requirement for certain telephone evaluation and management services. As a result, Medicare beneficiaries will be able to us an audio-only telephone to get these services.
5-10 minute telephone call with no video component, you would bill 99441, and Medicare would pay you the same as 99212.
11-20 minute telephone call, with no video component, you would bill 99213, and Medicare will pay you the equivalent of 99213.
21-30 minute telephone call with no video component, you would bill 99443, and Medicare will you pay you the equivalent of 99214
CMS will add new telehealth services on a sub-regulatory basis, considering requests by practitioners now learning to use telehealth as broadly as possible.
CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.
AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.
$1 billion through the Families First Coronavrius Response Act
$1 billion through the Paycheck Protection Program and Healthcare Enhancement Act
Additional funds from the $100 bill Provider Relief Fund will be allocated
Who is administering the program?
UnitedHealth Group through a contract with the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA)
What services are eligible for reimbursement?
Healthcare providers who provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursements through the program and will be reimbursed at Medicare rates, subject to available funding.
Specimen collection, diagnostic and antibody testing
Testing-related visits include the following settings: office, urgent care or emergency room, or via telehealth
Treatment, including office visit (including via telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care, acute inpatient rehab, home health, DME (e.g., oxygen, ventilator), emergency ambulance transportation, non-emergent patient transfers via ambulance, and FDA-approved drugs as they become available for COVID-19 treatment and administered as part of an inpatient stay.
FDA-approved vaccine, when available
How do eligible providers receive funding?
To receive funding, providers must attest to the following:
Agree not to balance bill the patient
Agree to program terms and conditions any maybe be subject to post-reimbursement audit review
Confirmed that the patient is uninsured, verified the patient does not have coverage such as individual, employer-sponsored, Medicare or Medicaid coverage, or no other pay will reimburse you for COVID-19 testing or treatment.
Accept defined program reimbursement as payment in full
What is the timeline for requesting and receiving reimbursement?
All claims submissions and claims reimbursements must be submitted and remitted electronically.
Enrollment started on April 27 for eligible providers.
Providers can submit claims starting May 6
Reimbursements can be expected mid-May
How are the reimbursement rates determined?
Reimbursement will be based on current year Medicare fee schedule rates except where otherwise noted
For any new codes where CMS published rate does note exist, claims will be held until CMS publishes corresponding reimbursement information
Claims submitted electronically for facility services will price according to traditional Medicare reimbursement
The following rates will apply for reimbursement of ambulance claims with a primary diagnosis of COVID-19
Ground ambulance: $350 per claim
Water ambulance: $350 per claim
Air ambulance: $2,300 per claim
Home health services will be priced based on a per-visit
All Medicare-eligible service categories: PT/OT/ST – $90
AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.
The Centers for Medicare & Medicaid Services (CMS) announced that it is suspending its Accelerated and Advance Payment Program (AAP) to Part B suppliers. With the successful payment of over $100 billion to healthcare providers and suppliers, CMS has started constructing guidelines for repayment along with additional funding.
As of today, April 28, 2020, CMS will not be accepting any new applications for the Advance Payment and will be reevaluating all pending and new applications for Accelerate Payments.
With over 25,000 applications, CMS is looking for providers and suppliers to pay back the funding within one year or less.
AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.
The Department of Health and Human Services (HHS) updated how it will distribute the remaining $70 billion of the Provider Relief Fund. The framework consists of 6 sections, general allocation, COVID-19 high impact areas, treatment of the uninsured, rural providers, Indian Health Service, and additional allocations.
General Allocation ($50 Billion)
HHS will supplement the initial $30 billion it distributed from the Provider Relief Fund with an additional $20 billion
The remaining $20 billion will begin distribution on April 24 to augment their allocation, so the whole $50 billion is allocated proportionally to providers’ share of 2018 net patient revenue.
HHS will calculate 2018 net patient revenue from cost reports that providers submit. Providers without adequate cost report date on file will need to submit their revenue information to the following portal: CARES Act Provider Relief Fund
Payments will go out weekly, on a rolling basis, as information is validated.
All recipients will be required to submit documents to ensure that the funds are used for healthcare-related expenses or lost revenue attributable to coronavirus.
COVID-19 High Impact Areas ($10 Billion)
$10 Billion will be distributed to hospitals in areas that are highly impacted by the coronavirus. Hospitals can apply for funding by providing four (4) pieces of information via an authentication portal before midnight PT, Thursday, April 23. The portal is live, and hospitals have already been contacted directly to provide the following information:
Tax Identification Number
National Provider Identifier
Total number of Intensive Care Unit beds as of April 10, 2020
Total number of admissions with a positive diagnosis for COVID-19 from January 1, 2020, to April 10, 2020
Treatment of the Uninsured
Although no specific amount is listed, healthcare Providers who provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursements through the program and will be reimbursed at Medicare rates, subject to available funding.
To participate, providers must attest to the following:
Agree not to balance bill the patient
Agree to program terms and conditions any maybe be subject to post-reimbursement audit review
Confirmed that the patient is uninsured, verified the patient does not have coverage such as individual, employer-sponsored, Medicare or Medicaid coverage, or no other pay will reimburse you for COVID-19 testing or treatment.
Accept defined program reimbursement as payment in full
Steps will involve: enrolling as a provider participant, checking patient eligibility and benefits, submitting patient information, submitting claims, and receiving payment via direct deposit
Providers can register for the program on April 27, 2020, and began submitting claims in early May. For more information: coviduninsuredclaim.hrsa.gov
Rural Providers ($10 Billion)
$10 Billion will be distributed to rural hospitals and rural health clinics (RHC).
The money will be distributed as early as next week on the basis of operating expenses.
The method recognizes the precarious financial position of many rural hospitals.
Indian Health Service ($400 Million)
$400 million will be allocated for the Indian Health Service facilities, distributed on the basis of operation expenses
The money will be distributed as early as next week
This will be used to complement other funding provided to IHS and work done to expand IHS capacity for telehealth
Additional Allocations
There are some providers who will receive further, separate funding as followed:
After a couple of weeks of negotiations, the House & Senate reached a deal on a $484 billion COVID-19 relief package, adding funding and enhancing programs from the CARES Act. The agreement segments into four (4) sections: $320 billion for small businesses, $75 billion for hospitals, $60 billion for the SBA disaster loan program, and $25 billion for disease testing.
$320 billion for small businesses (66%)
$310 billion for the Small Business Administration (SBA) Paycheck Protection Program (PPP).
$60 billion of the funding is set aside for businesses that do not have established banking relationships, such as rural and minority-owned companies.
$10 billion for the SBA’s Economic Injury Disaster Loan (EIDL)
The SBA stopped accepting new applications under the Paycheck Protection Program until funds were replenished. Banks anticipate that funding will run out in less than two (2) days. If you still need to apply for your Paycheck Protection Program Loan utilize our free resource to get started: Paycheck Protection Program – CARES Act
$75 billion for hospitals and healthcare providers (15%)
The bill provides $75 billion to the Department of Health and Human Services (HHS) to distribute to hospitals and healthcare providers for COVID-19 related expenses and lost revenue.
$60 billion for the SBA Disaster Loans Program (12%)
$60 billion in loans and grants for the Small Business Administration’s disaster relief fund.
$25 billion for disease testing (5%)
The $25 billion for disease testing will support federal efforts to research, develop, and produce COVID-19 tests.
$11 billion of this total is reserved for state and local governments for testing costs.
$1 billion to the Centers for Disease Control and Prevention (CDC) for various surveillance and epidemiologic purposes
$1.8 billion to the National Institutes of Health (NIH) for testing research.
$225 million will be distributed to rural health clinics, and $600 million will be distributed to community health centers
$1 billion is allocated for covering testing costs for uninsured people.
Who is AdvantEdge Healthcare Solutions?
AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.
As states and localities begin to stabilize, CMS recognizes the importance to restart care that is currently being postponed, such as surgeries and procedures, chronic disease care, and preventive care. As states and regions pass the Gating Criteria (symptoms, cases, and hospitals) and proceed to Phase 1, CMS created recommendations aimed to give healthcare facilities some flexibility in providing essential non-COVID-19 care to patients without symptoms of COVID-19 in regions with a low incidence.
General Considerations
In coordination with the State and local public health officials, analyze the incidence and trends for COVID-19.
Evaluate the necessity of care based on clinical needs.
Providers should prioritize surgical/procedural care and high-complexity chronic disease management.
Select preventive services may also be highly necessary.
Establish non-COVID Care zones (NCC) that would screen all patients for symptoms of COVID-19.
Sufficient resources should be available to the facility across phases of care.
PPE, a healthy workforce, facilities, supplies, testing capacity, and post-acute care.
Personal Protective Equipment
CMS recommends that healthcare providers and staff wear surgical facemasks at all times.
Staff should utilize appropriate respiratory protection such as N95 masks and face shields for the respiratory tract.
Patients should wear a cloth face covering that can be bought or made at home.
Every effort should be made to conserve personal protective equipment. Guidance can be found here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
Workforce Availability
Staffing levels in the community must remain adequate to cover a potential surge in CVOID-19 cases.
Staff should be routinely screened for symptoms of COVID-19.
Facility Considerations
The facility should create areas of NCC which have in place steps to reduce risk of COVID-19 exposure and transmission; these areas should be separate from other facilities to the degrees possible (i.e., separate building, or designated rooms or floor with a separate entrance and
minimal crossover with COVID-19 areas).
Established social distancing, such as minimizing time in waiting areas, spacing chairs at least 6 feet apart, and maintaining low patient volumes.
Visitors should be prohibited, but if needed, they should be pre-screened in the same way as a patient.
Sanitation Protocols
Ensure that there is an established plan for thorough cleaning and disinfection before using spaces or facilities.
Ensure that equipment such as anesthesia machines used for COVID-19 (+) patients are thoroughly decontaminated.
Supplies
Adequate supplies of equipment, medication, and supplies must be ensured.
Test Capacity
All patients must be screened for potential symptoms of COVID-19 before entering the NCC facility, and staff must be routinely screened.
When the adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory tests.
AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.
With the announcement on April 10, 2020, that $30 billion has been distributed to eligible providers throughout the healthcare system, the focus of physician practices shifted from receiving the funds to the signing the attestation within the next 30 days.
The attestation should be signed whether you plan to accept or reject the funds. If you are still deciding on your decision, we encourage you to utilize our free resources HHS Provides Guidance on Relief Funds and CARES Act Provider Relief Fund as restrictions and reporting requirements are required.
Below are 5 critical questions you should be asking your billing company, as the answers will help you determine the financial viability of your organization during this crisis and potentially beyond.
Is my billing company communicating with me regularly and updating me on their status?
Silence or lack of regular communication during this crisis is a signal for concern.
If they are not reaching out to you with answers to these and other questions they may either be overwhelmed or not comfortable sharing information on their status.
In either case, if they are not proactively communicating with you, you should be reaching out to them.
Is my billing company specialty specific?
Certain specialties have been hit excessively hard and reduction in volume will continue for several months
Most specialties heavily dependent on elective procedures (i.e. Anesthesia, Surgery, Plastics, and ASCs) have experienced a significant reduction in volume.
If your billing company specializes in a specific specialty or healthcare sector, now is the time to proactively communicate with them about how they are reacting to this dramatic reduction in cash flow – Are they financially positioned to continue to be “open for business”?
Is their staff still working (in the office or remotely)?
Notwithstanding the reduction in volume, some of your old A/R will now be a source of interim cash-flow while your practice activity is reduced. You still need to make sure the billing company is “open for business”
If they have laid off staff, how do they intend to ensure that as volume begins to increase, they will be able to ramp back up to meet those needs? Don’t forget; they will need to hire back and pay employees before they generate payments on your behalf and cash flow for their company. Are they financially positioned to achieve this?
If they have staff working remotely, what security provisions have been implemented to ensure they are operating in a HIPAA compliant environment?
Is the processing done in a geographically distributed model?
Billing companies with multiple locations may be in a better position to redistribute work to unaffected (or less affected) offices if one or more becomes a COVID-19 “hot spot.
Some states with Shelter at home mandates will “open” before others. Therefore, having multiple locations increases the likelihood that your work can be processed in a normal state sooner and reduces the risk of the prolonged impact of the virus on your cash-flow prolonged shutdowns will lead to gaps in claims processing resulting in delayed payments and significant cash-flow issues.
What is your billing company’s disaster recovery or business continuity plan?
Does my billing company outsource work to a 3rd party?
If so, what controls (and visibility) do you/they have over the 3rd party to which they outsource your claims processing?
How would that third party answer the questions above and how much influence over their actions/plans does your billing company have?
Shutdowns are in place in many countries where these 3rd parties operate. You should know whether this is happening and how your vendor is responding.
If you find your current in-house process or billing company may be vulnerable in any one of these areas, it may be time to look for alternatives or a least a contingency plan (Plan B). Having a Plan B doesn’t mean you’ve given up; it means you’re strategic and realistic about current events and their potential impact on the viability and success of your organization.
Adapting to change, such as major healthcare disruptions by COVID-19, is essential. Groups and healthcare organizations need to continue to monitor the situation, identify acute threats and modify current processes and business relationships to address areas of their business that are susceptible and could be negatively impacted by acute and potentially chronic threats to their business.
If AdvantEdge can be of resource to your organization, feel free to contact us at info@ahsrcmstg.wpengine.com
Who is AdvantEdge Healthcare Solutions?
AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.
The Department of Health & Human Services (HHS) has provided clarification regarding the Terms and Conditions when retaining the Relief Fund payments under the CARES Act. In the update below, HHS highlights two key guidelines focused on the concern that the provider must be currently treating actual or possible COVID-19 patients.
HHS now states, “care does not have to be specific to treating CVOID-19. HHS broadly views every patient as a possible case of COVID-19.” In other words, if you treated any patient, you treated a possible case of COVID-19, and you can breathe a sigh of relief knowing that you treated actual of possible COVID-19 patients.
HHS removed the requirement that you must be “currently” treating possible COVID-19 patients, such that if you “ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds.”
AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.
On March 27, 2020, the President of the United States signed the CARES Act that included $100 billion in relief funds to hospitals and healthcare providers, leading the COVID-19 response. The funding will be used to support healthcare-related expenses or lost revenue attribution to COVID-19 and ensure uninsured Americans can get testing and treatment.
With the announcement that $30 billion will be distributed April 10, 2020, to eligible providers throughout the healthcare system, the question is asked, who is eligible, what action is needed from eligible providers, how is payment distribution determined, how does this affect different types of providers?
Key Note: These are payments, not loans, and will not need to be repaid.
Eligibility
All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019
Providers must agree not to seek collection of out-of-pocket payments from COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider
Providers impacted by the COVID-19 pandemic and providers who are struggling to keep operations running due to delayed care or canceled elective services.
Process for an Eligible Provider
Providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS)
The payment will come to providers via Optum Bank with “HHSPAYMENT” as the payment description
Providers who regularly receive a paper check for reimbursement from CMS can expect to receiver a paper check of payment within the next few weeks.
Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment.
Distribution will be based on their share of total Medicare FFS reimbursements in 2019. (Total FFS payments were approximately $484 billion in 2019)
Example: You billed Medicare FFS for $70 million in 2019.
$70,000,000/$484,000,000,000 x $30,000,000,000 = $4,338,842
Different Type of Providers
All relief payments are being made to providers and according to their tax identification number (TIN)
Large Organizations and Health Systems
Relief payments will be received for each of their billing TINs that bill Medicare.
Employed Physicians
Employed physicians should not expect to receive an individual payment directly. The employer organization will receive the relief payment as the billing organization
Physicians in a Group Practice
The group practice will receive the relief fund payment as the billing organization.
Solo Practitioners
Will receive a payment under the TIN used to bill Medicare
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