Repayment of COVID-19 Accelerated and Advance Payments

If a provider received a COVID-19 accelerated or advance payment, CMS is starting to recoup any outstanding balance from the provider’s Medicare payments.    This process began on March 30, 2021, but generally starts on the one-year anniversary of when the provider received the first accelerated or advanced payment.

CMS will show the recoupment on the remittance advices issued for Medicare Part A and B claims processed after the one year anniversary of issuing the first payment.   The recoupment will appear as an adjustment in the Provider-Level Balance (PLB) section of the remittance advice.

The terms for repayment are as follows:

  • Repayment does not begin for one year starting from the date the accelerated or advance payment was issued.
  • Beginning at one year from the date the payment was issued and continuing for eleven (11) months, Medicare payments will be recouped at a rate of 25%.
  • After the eleven (11) months end, Medicare payments will be recouped at a rate of 50% for another six (6) months.
  • After the six (6) months end, a Letter Requiring Reimbursement for any remaining balance of the accelerated or advance payment(s) will be issued for payment within 30 days from the date of the letter (i.e., to repay the balance in full). If payment is not received within 30 days, interest will accrue at the rate of 4% from the date the letter was issued, and will be assessed for each full 30-day period that the balance remains unpaid.    Information related to Extended Repayment Schedules will be included in these letters.  CMS may immediately issue these letters to providers and suppliers who received accelerated or advance payments in error.

Provider and Supplier Assistance: For questions related to the Accelerated and Advance Payment Program, CMS has established COVID-19 hotlines at each MAC that are operational Monday – Friday to assist you with accelerated or advance payment concerns. You can contact the MAC that services your geographic area. To locate your designated MAC, see this CMS Fact Sheet or visit https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.

More details are available in the CMS ACCELERATED AND ADVANCE PAYMENT REPAYMENT & RECOVERY FREQUENTLY ASKED QUESTIONS.

 

Repayment and Reconciliation Terminology:

Extended Repayment Schedule (ERS) is a statutorily authorized debt installment payment schedule, which allows a provider or supplier experiencing financial hardship to pay debts over the course of three years. This can be extended to as many as five years, where certain extreme hardship criteria are met. Providers and suppliers are able to request ERSs after demand letters are issued. Providers and suppliers should contact their MAC for information on how to request an ERS.

Recoupment means the recovery by Medicare of any outstanding Medicare debt by reducing present or future Medicare payments and applying the amount withheld to the indebtedness (42 CFR 405.370). For the purposes of recovering accelerated and advance payments, recoupment means the recovery by Medicare of any outstanding Medicare accelerated and advance payment loans by reducing present or future Medicare payments and applying the amount withheld to the outstanding loan balance.

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