August 7, 2020

Provider Relief Fund Grants Offer COVID Relief for Health Care Organizations

The CARES Act Provider Relief Fund is designed to support American families, workers, and healthcare providers in the battle against the COVID-19 outbreak. The U.S. Department of Health and Human Services (HHS) is distributing $175 billion in grants to hospitals and healthcare providers on the front lines of the coronavirus response. Providers that have not yet received funding can still apply before August 28.

Details of Provider Relief Funding

The intent of the HHS grant funding is to support healthcare-related expenses or lost revenue attributable to the coronavirus and ensure all Americans have access to the care they need. The initial $30 billion was allocated based on the facilities’ and providers’ share of 2019 Medicare fee-for-service (FFS) reimbursements. These were payments, not loans, to healthcare providers and are not required to be repaid.

Timeline of Provider Relief Fund Grant Distribution

  • On April 10, 2020, HHS began distributing the initial $30 billion in relief funding to eligible providers throughout the American healthcare system. 
  • On April 24, a portion of providers were automatically sent an additional advance payment based off the revenue data they submitted in CMS cost reports.  Providers without adequate cost report data on file needed to submit their revenue information for additional General Distribution funds.
  • On June 9, Phase 2 of General Distribution began with $15 billion sent to eligible Medicaid, CHIP and dental providers and $10 billion to safety net hospitals.
  • On June 10, HHS launched an enhanced Provider Relief Fund Payment Portal that allowed eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider will be at least 2% of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.
  • On July 10, the HHS, through the Health Resources and Services Administration (HRSA), announced approximately $3 billion in funding to hospitals serving a large percentage of vulnerable populations on thin margins and approximately $1 billion to specialty rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals in small metropolitan areas. HHS is also opening the provider portal to allow dentists to apply for relief. 
  • On August 7, the HHS announced $5 billion in allocations of CARES Act Provider Relief Fund for nursing homes. HRSA expects the initial $2.5 billion nursing home distribution to occur in mid-August. This will be followed by additional performance-based distributions throughout the fall.

View the full CARES Act Provider Relief Fund Distribution Timeline.

Terms and Conditions of Provider Relief Funding

Within 30 days of receiving the payment, providers are required to sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment via an online portal. Providers that do not accept the Terms and Conditions after 90 days of receipt will be deemed to have accepted the Terms and Conditions.

All recipients will be required to submit sufficient documents to ensure that these funds were used for healthcare-related expenses or lost revenue attributable to coronavirus. There will be significant anti-fraud and auditing work done by HHS, including the work of the Office of the Inspector General.

A condition to receiving these funds is providers must agree not to seek collection of out-of-pocket payments from a presumptive or actual 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.

Provider Relief Funding and PPP Loans

The monies received from the HHS funding cannot be used for payments to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. Additional reporting is required for recipients receiving more than $150,000 in total funding.

Applying for Provider Relief Funding

The original funding did not require any application or request for the monies, as it was based off prior claims data. To be eligible for a Provider Relief Fund grant going forward, health care providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020. Close to one million health care providers may be eligible for this funding. 

Applications are currently open for the General Distribution (Phase 2) to Medicaid, Medicaid managed care, Children’s Health Insurance Program (CHIP) and dental providers. Providers that have not yet received funding and would like to apply can download the Provider Distribution Instructions and apply in the Provider Relief Fund Application and Attestation Portal. Applications must be submitted by Aug. 28, 2020.

Our advisors are closely following COVID-19 relief efforts and will continue to publish insights to keep you informed about potential impacts and benefits. Visit our COVID-19 Resource Center for more insights or contact Anders below to discuss how we can help you along the Provider Relief Funding process.

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August 4, 2020

Will Telehealth Services Continue Beyond COVID-19?

There is no doubt the COVID-19 pandemic has rocked the American healthcare industry. Organizations have had to quickly adapt to their critical role on the front lines, often at the price of suspending traditionally profitable service lines, causing massive uncertainty in financial planning. One way providers have mitigated these losses is with the rapid adoption or expansion of their offered telehealth services. The benefits are clear: practitioners can continue to service patients and generate revenue while patients feel secure receiving care without risk of disease exposure. But can telehealth be profitable in addition to providing a crucial service to patients?

Growing Profits with Telehealth

In the short-term, demand for telehealth has exploded and an increase in claims from just 0.17% of all claims in March 2019 to 7.52% of claims one year later and projected spending of up to $250 billion in the U.S. by the end of 2020. Additionally, to minimize the financial hit taken by providers during the COVID-19 pandemic, reimbursement rates for telehealth services have been set to match the rates for in-person encounters whereas in the past payers have generally reimbursed at a lower rate. This change may ultimately revert, but there is growing support in Congress to make the policies incentivizing telehealth use by Medicare beneficiaries permanent, and as patients adapt to telehealth encounters, demand is predicted to stay high. Clearly telehealth can be profitable, but there are concerns about sustainability.

Planning for Future Demands

Health care organizations must account for telehealth’s expanded importance in their financial planning and they will need to consider the service lines that have seen increased demand since the beginning of the pandemic; chiefly primary care, but also oncology, dermatology, and emergency medicine. Organizations will also need to factor in expanded access to traditionally popular services such as psychiatry, radiology and cardiology. Scrupulous review of patient throughput data will be necessary to project revenues as generally telehealth encounters are faster and practitioners can be more efficient without travel time between patients, which creates an opportunity for higher patient service volumes. Lower operating costs also factor into forecasting revenues, as fewer in-person encounters will decrease staffing and supply demands. As the U.S. opens back up and suspended healthcare operations return, it will be important to monitor how the change in demand for telehealth shifts, but the foundation is certainly promising.  

Telehealth is Here to Stay

Utilization of virtual healthcare has been steadily growing in recent years, and the COVID-19 pandemic has outlined not only how essential the platform is for mitigating revenue loss for health care organizations, but how much potential there is for growth as well. Patients are perpetually growing more accustomed to an online healthcare platform across a variety of specialties and as demand increases, there are lucrative opportunities for organizations to provide these services. Furthermore, there is mounting public and political support to make the temporary increase in Medicare reimbursement rates for telehealth encounters permanent after the worst of the pandemic has passed. There has never been a better environment to demonstrate the importance of telehealth, and there is little doubt that these services will continue to be instrumental to success in the health care industry moving forward.

How is your health care organization adjusting to the rise of telehealth services? The Anders Health Care Group is here to help telehealth providers reduce operating costs and increase collections. Contact an Anders advisor below to discuss your specific business goals.

Anders Health Care intern Nick Sterner contributed to this post.

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April 3, 2020

CMS Offers Accelerated and Advance Medicare Payments for Physicians, Providers and Suppliers

As part of the CARES Act, the Centers for Medicare & Medicaid Services (CMS) is authorizing accelerated and advance payments to any Medicare physicians, provider or supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the qualification requirements. The Accelerated and Advance Payment Program is for the duration of COVID-19.

To qualify for advance/accelerated payments physicians, providers or suppliers must:

  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the physician’s request form
  • Not be in bankruptcy
  • Not be under active medical review or program integrity investigation
  • Not have any outstanding delinquent Medicare overpayments

Amount of Payment for Physicians

Qualifying physicians can request up to 100% of the Medicare payment for a previous three month period.  This can be a good faith estimate. Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100% of the Medicare payment amount for a six-month period.  Critical Access Hospitals (CAH) can request up to 125% of their payment amount for a six-month period.

Processing Time

The processing time is determined by each MAC, but expected to be issued within 7 calendar days of receipt of the request.

Repayment

CMS has extended the repayment of these accelerated/advance payments to begin 120 days after the date of issuance of the payment. Physicians billing under Part B will have 210 days from the date of the accelerated or advance payment was made to repay the balance.

  • Inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and Critical Access Hospitals (CAH) have up to one year from the date the accelerated payment was made to repay the balance.
  • All other Part A providers and Part B suppliers will have 210 days from the date of the accelerated or advance payment was made to repay the balance.

Below is an example of the CMS timeline.

Learn more about the advanced payment timeline in the CMS Fact Sheet.

Our advisors are closely following COVID-19 relief efforts and will continue to publish insights to keep you informed about potential business impacts and benefits. Visit our COVID-19 Resource Center for more news, tools and insights you need to know in these uncertain times. Contact an Anders advisor to learn more about

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