The CARES Act: Your 17 top questions answered
The Coronavirus Aid, Relief, and Economic Security (CARES) Act has extended much-needed funding to healthcare practices beleaguered by the COVID-19 pandemic. This $2 trillion federal stimulus package offers relief through small business loans, expedited Medicare reimbursements, expanded telemedicine services, and other avenues.
In a recent webinar, we explored how the CARES Act could benefit your practice. Webinar participants chimed in with great questions, which we’ve answered below. Read on for responses to the 17 top questions, plus links to helpful resources!
Q: How long must I wait for PPP approval?
A: As of April 16, 2020, the Small Business Administration (SBA) is no longer accepting applications for this program. If you applied for a loan through this fund, please contact your lender for updates. If we learn this program has been extended, we will share that update.
Q: How much of my PPP loan will I need to pay back? How much will be forgiven?
Q: Can a medical practice seek funding through the PPP and the SBA’s Economic Injury Disaster Loan (EIDL)?
A: Yes, participation in one program would not disqualify a practice from applying to the other. However, the SBA is no longer accepting applications for the PPP or the EIDL.
Q: Can I roll over a portion of my EIDL to the PPP and have it forgiven?
A: Please address this situation with your lender.
Public Health and Social Services Emergency Fund (also known as the CARES Act Provider Relief Fund)
Q: Do I need to apply for the Public Health and Social Services Emergency Fund?
A: Of the $100 billion the CARES Act added to this fund, $30 billion was dispersed in early April to actively enrolled Medicare providers. View this fact sheet to learn more. On April 23, the Department of Health & Human Services (HHS) announced how the remaining $70 billion will be dispersed (see below).
- An additional $20 billion of the CARES Act Provider Relief Fund is allocated for general distribution to Medicare facilities and providers. When included with the $30 billion distributed in early April to Medicare-enrolled providers based on 2019 Fee-for-Service (FFS) reimbursements, the total distributed to Medicare providers equals $50 billion.
- HHS will begin distribution of the remaining $20 billion of the general distribution to these providers to augment their allocation. The entire $50 billion general distribution is allocated proportional to providers' share of 2018 net patient revenue.
- On April 24, a portion of providers will automatically be sent an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file will need to submit revenue information via a portal opening this week on the CARES Act Provider Relief Fund page to receive the additional general distribution funds.
- $10 billion will be allocated for a targeted distribution to hospitals in areas that have been especially impacted by the COVID-19 outbreak. As an example, hospitals serving COVID-19 patients in New York, which has a high percentage of total confirmed COVID-19 cases, are expected to receive a large share of the funds.
- $10 billion will be allocated for rural health clinics (RHCs) and hospitals, most of which operate on very narrow margins and are far less likely to be profitable than their urban counterparts.
- The remaining $30 billion can be used to reimburse hospitals at Medicare rates for the treatment of uninsured patients. Of this amount, $400 million will be allocated for Indian Health Service (HIS) facilities, distributed on the basis of operating expenses.
Q: When can Medicare providers expect to receive funds?
For details on how eligible providers will receive payment, please consult the HHS page about the CARES Act Provider Relief Fund.
Q: Are Medicaid providers eligible for payment?
A: Currently, it appears that Medicaid providers will not be distributed funds directly. For more information, visit the CARES Act Provider Relief Fund page.
Q: Can community health centers (CHCs) receive funds from both the Public Health and Social Services Emergency Fund and CHC funding?
A: Yes, it is possible for designated CHCs that are also enrolled in Medicare or Medicaid to receive funding from both sources.
Q: Who should I contact if I don’t receive the HHS funds for Medicare providers?
A: If you are paid through an employer that is assigned your billing rights, the funds would have gone to your employer’s account. If you normally receive a paper check from the Centers for Medicare & Medicaid Services (CMS), you can expect to receive a paper check in the next few weeks. (Please note: If you did not bill Medicare in 2019, you are not eligible to receive these funds.)
Q: Where do I sign the attestation confirming receipt of the funds and agreeing to the terms and conditions of payment?
Q: Do I need to keep a record of how these funds are spent? Or do I need to keep a record only if I request more funds?
A: Yes, you must maintain records that you can make available to HHS in the event of a request or audit. To understand the fund’s requirements and limitations, consult questions 5-9 in this article from the National Law Review. You can also view the terms and conditions of the CARES Act Provider Relief Fund for more details.
Q: Should I set aside these funds specifically for personal protective equipment (PPE)?
A: You can, but you do not have to. The terms and conditions state that the funds must be used to “prevent, prepare for, and respond to coronavirus” for “health care related expenses or lost revenues that are attributable to coronavirus.”
Accelerated and Advance Payment Program
Q: How will repayment proceed under the Accelerated and Advance Payment Program? In 120 days, will CMS begin to reduce payments by a certain amount each month?
A: The plan announced by CMS had indicated that reimbursements back to CMS for advance payments would be taken out of future claims submitted, at some point following the 120-day grace period. However, on April 26, CMS announced that it was suspending and "re-evaluating" this program.
The press release states: “Since expanding the AAP programs on March 28, 2020, CMS approved over 21,000 applications totaling $59.6 billion in payments to Part A providers, which includes hospitals. For Part B suppliers, including doctors, non-physician practitioners and durable medical equipment suppliers, CMS approved almost 24,000 applications advancing $40.4 billion in payments. The AAP programs are not a grant, and providers and suppliers are typically required to pay back the funding within one year, or less, depending on provider or supplier type. Beginning today, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through the Department of Health & Human Services’ (HHS) Provider Relief Fund.”
Q: Can I provide telemedicine visits to new Medicare patients?
A: Yes. For the duration of the public health emergency, CMS has increased flexibility for Medicare telehealth options, including telemedicine visits for new patients. See this resource from CMS to learn more.
Q: What resources would you recommend for federally qualified health center (FQHC) telemedicine billing? Are there certain Place of Service (POS) codes or modifiers for CPT codes needed for FQHC compared to non-FQHC?
A: To learn more about how the CARES Act and public health emergency impact FQHCs and rural health clinics (RHCs), view this resource.
You can also consult the following:
- FAQ on Telehealth and HIPAA during the COVID-19 nationwide public health emergency
- Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency
- Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19
- Medicare Telemedicine Health Care Provider Fact Sheet
Q: Does the Federal Communications Commission (FCC) COVID-19 Telehealth Program offer grants that need to be repaid?
A: No, it is not a grant program. The program’s FAQ page states, “To receive disbursements, eligible health care providers that are approved for funding will be required to submit an invoicing form and supporting documentation in order to receive reimbursement for eligible expenses and services. Applicants who receive funding will be required to comply with all program rules and requirements, including applicable reporting requirements, and may be subject to compliance audits.”
If you would like to take advantage of this program, we urge you to submit an application as soon as possible. Only days after the program opened, the first recipients were already awarded funds. If you have questions regarding this program, see the bottom of this public notice for FCC contact information.
Q: Can we bill Medicare for patients who have lost their jobs and health insurance?
A: If reimbursable healthcare services were provided to a Medicare patient with continuing coverage even after job loss, the same billing processes and conditions of participation should apply. Continue to verify patient health insurance per normal administrative and billing processes.
Medicare allows Medicare Advantage Plans to waive cost sharing for COVID-19 lab tests. Some private insurers have similar allowances to waive cost-sharing and copay costs related to COVID-19. Review these allowances carefully during the billing process.
Under the CARES Act, terms and conditions apply to federal funds used by practices to treat patients. The CARES Act Provider Relief Fund has limitations, for example, on billing out-of-pocket expenses (up to the in-network maximum) to patients for COVID-19 related treatment. See page two of the fund’s terms and conditions.