The Health Law Ticker

On March 28, 2020, the Centers for Medicare & Medicaid Services (“CMS”) announced that the agency would provide relief to Medicare providers and suppliers by expanding the Accelerated and Advance Payment Program for the duration of the COVID-19 public health emergency.  According to CMS’ guidance, to qualify for accelerated or advance payments, the provider or supplier must:

• Have billed Medicare for claims within the prior 180 days
• Not be in bankruptcy
• Not be under active medical review or program integrity investigation
• Not have any outstanding delinquent Medicare overpayments 

That is good news for most providers and suppliers. 

On the other hand, CMS has yet to clarify the scope of these eligibility criteria.  For example, what type of existing audit would qualify as an “active medical review,” thereby rendering a provider or supplier ineligible for the program?

To exacerbate the uncertainty, the Medicare Administrative Contractors (“MACs”) have developed inconsistent certification language on their Accelerated and Advance Payment Request forms.  For example, in one case, the MAC requires a provider or supplier to certify that it is not currently in bankruptcy on the form.  In another case, a provider or supplier is only required to certify that it “has no plans to file for bankruptcy” and “cease doing business.”

We have delved into some of these eligibility questions which invariably have required a case-by-case review.  If your organization is unsure about its eligibility or application for accelerated and advance payment by Medicare, we are available to assist.