Compliance

Beginning April 10, 2020, the U.S Department of Health & Human Services will begin to distribute $30 billion of funds via direct deposit to eligible providers. These are not loans, they are payments without any repayment terms. All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible.

The conditions for these payments are as follows:

  • Providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that exceed what the patient would have paid if the care was provided by an in-network provider
  • 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. The portal for signing will be made available in the coming days at this site: https://www.hhs.gov/provider-relief/index.html
  • The full terms and conditions can be found here: https://www.hhs.gov/sites/default/files/relief-fund-payment-terms-and-conditions-04092020.pdf
  • The terms include stipulations, such as:
    • The recipient must not be terminated from participation in Medicare
    • The recipient must provide, diagnose, test or care for individuals with possible or actual cases of COVID-19. Note the terms do not require the provider to deliver COVID-19 related care, simply that patients of the provider may have had COVID-19.
    • The payment must be used to prevent, prepare for and respond to coronavirus and shall reimburse the recipient only for health care related expenses or lost revenues attributable to coronavirus
    • The recipient will be required to submit reports to ensure compliance with the above conditions.
    • And other stipulations expressly limiting the use of such funding to exclude use towards things such as executive pay, lobbying, abortions, and other limitations and general stipulations

The amount of payments for each provider will be distributed based on the 2019 portion of their total Medicare FFS reimbursements in 2019, which totaled $484 billion in 2019, multiplied by $30 billion. For example, if a provider billed $100k of Medicare FFS reimbursements in 2019, they would receive $100k/$484B times $30B. Such a practice would receive roughly $6,200. Another way to calculate this is that the practice would receive roughly 74% of what their average monthly Medicare billing would be for 2019.

HHS has partnered with UnitedHealth Group (UHG) to provide these payments. Payments will received under the TIN used to bill Medicare and will come directly to the account on file with CMS or on file with UHG, provided via Optum Bank with “HHSPAYMENTas the payment description. Providers who normally receive a paper check for CMS reimbursements will receive a paper check in the mail for this payment within the next few weeks.

Please note that I am not a lawyer or legislator, but my personal opinion of the above is that some providers may be challenged to know with certainty whether any of their patients may have possible cases of COVID-19. For example, a specialist practice that is not involved with the primary care of its patients may simply not be informed by their patients of possible cases of COVID-19. One way to ascertain this may be through participation in a regional Health Information Exchange (HIE), or it may be sufficient for a provider to attest that they are in an area wherein there are confirmed cases of COVID-19. It is my hope that, demonstrated by the proactive direct deposit of these funds, the intention would not be to aggressively “claw back” the payments on the basis of this distinction; however, time will tell. I will note that the stipulations also call for the funding to be used directly in response to COVID-19, or to reimburse lost revenues attributable thereto. My personal opinion is that the latter should be fairly easy to prove, simply based on difference in a practice’s billing from before to after the “stay at home” orders issued across the nation. However, for practices that are looking to provide documented disbursements in response to COVID-19, technology spending on things such as Telehealth, Practice Support, Hosted solutions or anything else enabling remote delivery of care I expect would qualify.

– Ben Scharfe, Amazing Charts

Ben Scharfe is a CPA, CA who has been with Harris Healthcare for over five years and is currently a member of the Amazing Charts leadership team.

For more information and resources for handling the COVID-19 crisis, visit our dedicated COVID-19 page here.