CARES Act Provider Relief Fund

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.
  • Department of Health & Human Services – Relief Fund Payment Terms and Conditions 

Payment Distribution

  • 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

Please visit https://www.hhs.gov/provider-relief/index.html for more information about the CARES Act Provider Relief Fund.

Sources: The Department of Health & Human Services: CARES Act Provider Relief Fund

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