On Friday, April 10, 2020, the United States Department of Health and Human Services (HHS) announced the release of the provider relief funds authorized by the CARES Act. These funds will provide $100 billion to hospitals and healthcare professionals treating patients with COVID-19. Unlike the accelerated and advanced payments, which are considered loans, the relief funds will not require repayment by healthcare professionals if certain conditions are met.

Eligible providers will see these relief funds directly deposited into the account associated with the provider’s Medicare fee-for-service account. HHS indicated that it will immediately release $30 billion for providers that meet the following criteria:

• Facilities, group practices or solo practitioners associated with a Tax Identification Number (TIN) that received payments from the Medicare fee-for-service program in 2019.
• Entities that agree to only collect costs from COVID-19 patients up to the in-network out-of-pocket maximums even if the entity may be entitled to greater reimbursement.
• Organizations that treated individuals with possible or suspected cases of COVID-19, even if the entity have since ceased practice operations.
• Maintain active enrollment in the Medicare program (i.e., not terminated or excluded, and billing privileges not revoked).

For providers meeting the criteria above, funds will be deposited under the payment description “HHSPAYMENT” or through a paper check sent by mail. According to the HHS, each billing TIN may estimate its payment through this formula: [TIN’s 2019 Medicare Fee-for-Service Billing/$484 Billion] * $30 Million = Estimated Relief Payment.

Payments should be utilized to “prevent, prepare for, and respond to coronavirus” and payments may not be used to reimburse for expenses or losses payable by other sources. HHS will develop reports that must be submitted to track spending. For entities receiving more than $150,000 total funds from the various COVID-19 stimulus funds, HHS will require a quarterly report due 10 days after the end of the quarter that details specific spending measures. A complete copy of the Terms and Conditions is located here.

HHS is requiring all providers to sign the Terms and Conditions statement within 30 days of receiving the payment. Signatures may be submitted through an online portal that will be made available to providers this week. Failure to sign the Terms and Conditions statement will be deemed acceptance, if the funds are not returned. For providers that choose to refund the money, HHS will make instructions available on how to process the return.

Dedicated personnel should be trained to understand the reporting associated with receiving these payments and other COVID-19 payments, such as accelerated and advanced payments. This will ensure proper tracking of payments and compliance requirements.

Authorship Credit: Ernessa McKie and Amy Fouts