The US Treasury, Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) have implemented financial relief and regulatory flexibility to support health care entities through the unparalleled impact of the COVID-19 pandemic.
On May 20, 2020, Kelly Saunders, Chris Anusbigian, and Linsday Wisdom of Deloitte presented a webinar through the MA-RI chapter of HFMA on these important changes and have further summarized them here. For further details, follow this link to the recorded webinar and presentation from May 20, 2020.
A total of $175 billion has been allocated for the Provider Relief Fund, including $100B through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and $75B through the Paycheck Protection Program and Health Care Enhancement Act. To date, roughly $70.4B has been allocated across Medicare fee-for-service providers, high-impact areas, rural providers and Indian Health Service. A significant portion of the Provider Relief Fund, roughly $104.6B, has yet to be distributed. However, HHS has stated that a portion of the remaining amount will be used to reimburse for uninsured patients and certain other provider types, including skilled nursing facilities, dentists and providers who solely accept Medicaid.
HHS offers guidance in the CARES Act Relief Fund FAQs, (link to https://www.hhs.gov/sites/default/files/provider-relief-fund-general-distribution-faqs.pdf) on a variety of topics aimed at assisting organizations as they prepare to accept, return, and/or apply for additional funding through the General Distribution attestation portal. Importantly, HHS has stated that funds determined to be overpaid or paid in error should be rejected in their entirety, and providers should submit the appropriate revenue documents through the General Distribution portal to facilitate HHS determining correct payment. Additionally, if providers believe they have been underpaid, they should accept the payment and submit their revenues in the provider portal to determine correct payment.
Further FAQs on balance billing, situations where organizations/facilities have been recently purchased or sold, new TIN owners, and whether a provider that owns several hospitals has discretion to allocate throughout the system can be found using the link provided above.
Key Dates and Deadlines
For entities in receipt of funds from the General Distribution, the Provider Relief Fund attestation must be completed via the CARES Act Provider Relief Fund Payment Attestation Portal within 45 days of receipt of funds; this includes agreement to the accepted amount and the Terms and Conditions.
If the amount an entity has received to date does not cover lost revenue or increased expenses, requests for additional funds from the General Distribution can be made via the Attestation Portal by submitting the required supporting financial documentation. The deadline to request additional funds is June 3, 2020.
We recommend monitoring the HHS website and the HFMA COVID-19 News page (link to https://www.hfma.org/topics/coronavirus.html) for updates.
Waivers & Telehealth
CMS has issued blanket waivers (link to https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf) for certain hospital conditions of participation, flexibility across types of facilities types and expansion of telehealth services. These blanket waivers are retroactively effective from March 1, 2020 through the declared end of the public health emergency.
CMS has promoted the use of telehealth services through removing geographic restrictions, expanding the types of allowed providers, increasing telehealth reimbursements to in-person fee-for-service rates and, through Office of Civil Rights (OCR) direction, allowed use of readily-available applications such as Apple FaceTime, Zoom and Skype. Please reference the recording and presentation through the link above for details on specific telehealth coding and billing information.
While support is available to help navigate the clinical, operational and financial hardship caused by COVID-19, knowing how to appropriately use the resources and relief is vital to success. Please stay on the lookout for future HFMA webinar sessions around COVID-19 current events.
About the Authors:
Kelly J. Sauders is a Partner at Deloitte & Touche LLP with over 25 years of experience in the health care industry. She specializes in providing regulatory compliance, risk and control-related services.
Chris Anusbigian is a Specialist Leader at Deloitte & Touche LLP. Chris has over 30 years of experience working with health care and life sciences organizations around regulatory requirements, third-party payor billing rules and compliance programs.
Lindsay Wisdom is a Manager at Deloitte & Touche LLP where she assists organizations in developing solutions and strategies to address a variety of complex organizational and regulatory risks and challenges.
Dhara Satija, Senior Manager and Tully Saunders, Manager, from Deloitte & Touche LLP also contributed to this blog and webinar.