April 15, 2020
Area(s) of Interest: Payor Issues and Reimbursement
On April 10, 2020, the U.S. Department of Health and Human Services (HHS) began sending FFS Medicare-enrolled physicians direct deposit disbursements totaling $30 billion. The lump sum payments will go to each physician organization’s TIN that normally receives Medicare payments. The $30 billion is part of the $100 billion Public Health and Emergency Fund created by the Coronavirus Aid, Relief and Economic Security Act (CARES Act) to provide financial assistance to physician practices, hospitals and other providers negatively impacted by the COVID-19 pandemic.
Each physician organization receiving these grants will need to attest to certain HHS terms and conditions within 30 days of receiving the grant. Yesterday HHS clarified the terms and conditions in response to organized medicine’s concerns. In agreeing to the terms and conditions of the grants, physicians were being required to attest that they “diagnose, treat or test patients for COVID-19.” The American Medical Association (AMA), on behalf of organized medicine, argued that the language inappropriately narrowed physician use of the funding. In response, HHS has now modified some of the language to make its meaning more clear, stating that every patient is a possible case of COVID-19.
The website at hhs.gov/provider-relief now includes the following statement: “If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.”
Also, the second provision of the terms and conditions has been changed to no longer say providers attest to "currently" taking care of patients, just that they did so after January 31, 2020.
Physicians must also attest that they will not balance bill patients “for all care for a possible or actual case of COVID-19.”
A second wave of payments from the CARES Act Public Health and Emergency Fund should be going out soon. HHS said it is working to disburse additional funding to providers with lower shares of Medicare reimbursement (such as pediatricians, allergists and OB-GYNs) and Medicaid providers, and for COVID-19 treatment for the uninsured.
HHS will have the new terms and conditions posted on its website by April 18, 2020.
For physicians who believe they are eligible but have not yet received funding, see “Wondering where your HHS stimulus payment is?”