What is the accelerated and advance payment program for Medicare?
- Accelerated and advance Medicare payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing.
- These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.
- The payments can be requested by hospitals, doctors, durable medical equipment suppliers, and other Medicare Part A and Part B providers and suppliers.
How can a Healthcare Provider qualify for this program?
To qualify for accelerated or advance payments, the provider or supplier must:
- Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form,
- Not be in bankruptcy,
- Not be under active medical review or program integrity investigation, and
- Not have any outstanding delinquent Medicare overpayments.
When can I get an advance?
Medicare will start accepting and processing the Accelerated/Advance Payment Requests immediately. CMS anticipates that the payments will be issued within seven days of the provider’s request.
Full Guide: How to Request Accelerated or Advance Payment from Medicare
1. Complete and submit a request form
Accelerated/Advance Payment Request forms vary by contractor and can be found on each individual MAC’s website. Complete an Accelerated/ Advance Payment Request form and submit it to your servicing MAC via mail or email. CMS has established COVID-19 hotlines at each MAC that are operational Monday – Friday to assist you with accelerated payment requests. You can contact the MAC that services your geographic area. To locate your designated MAC, refer to this link
2. What to include in the request form?
Incomplete forms cannot be reviewed or processed, so it is vital that all required information is included with the initial submission. The provider/supplier must complete the entire form, including the following:
a. Provider/supplier identification information:
i. Legal Business Name/ Legal Name;
ii. Correspondence Address;
iii. National Provider Identifier (NPI);
iv. Other information as required by the MAC.
b. Amount requested based on your need:
i. Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period. However, 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 now request up to 125% of their payment amount for a sixmonth period.
c. Reason for request:
i. Please check box 2 (“Delay in provider/supplier billing process of an isolated temporary nature beyond the provider’s/ supplier’s normal billing cycle and not attributable to other third party payers or private patients.”); and
ii. State that the request is for an accelerated/advance payment due to the COVID19 pandemic.
3. Who must sign the request form?
The form must be signed by an authorized representative of the provider/supplier.
4. How to submit the request form?
While electronic submission will significantly reduce the processing time, requests can be submitted to the appropriate MAC by fax, email, or mail. You can also contact the MAC provider/supplier helplines listed above.
5. What review does the MAC perform?
Requests for accelerated/advance payments will be reviewed by the provider or supplier’s servicing MAC. The MAC will perform a validation of the following eligibility criteria:
• Has billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s or supplier’s request form,
• Is not in bankruptcy,
• Is not under active medical review or program integrity investigation,
• Does not have any outstanding delinquent Medicare overpayments.
6. When should you expect payment?
The MAC will notify the provider/supplier as to whether the request is approved or denied via email or mail (based on the provider’s/supplier’s preference). If the request is approved, the payment will be issued by the MAC within 7 calendar days from the request.
7. When will the provider/supplier be required to begin repayment of the accelerated/ advanced payments?
Accelerated/advance payments will be recovered from the receiving
provider or supplier by one of two methods:
• For the small subset of Part A providers who receive Period Interim Payment (PIP), the accelerated payment will be included in the reconciliation and settlement of the final cost report.
• All other providers and suppliers will begin repayment of the accelerated/advance payment 120 calendar days after payment is issued.
8. Do provider/suppliers have any appeal rights?
Providers/suppliers do not have administrative appeal rights related to these payments. However, administrative appeal rights would apply to the extent CMS issued overpayment determinations to recover any unpaid balances on accelerated or advance payments.