ASOA COVID-19: News You Can Use

June 11, 2020

HHS Announces Additional Distributions from Provider Relief Fund; Launches Enhanced Provider Portal and Updates FAQs

On June 9, the U.S. Department of Health and Human Services (HHS) announced it is moving forward with additional distributions from the Provider Relief Fund. HHS expects to distribute approximately $15 billion to eligible physicians and organizations that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation.

HHS also launched an enhanced portal for Medicaid and CHIP providers to report their annual patient revenue and necessary information to receive a payment equal to at least 2% of reported gross revenues from patient care.

In addition, HHS has once again updated its FAQs regarding the CARES Act Provider Relief Fund.

June 1, 2020

HHS Updates its CARES Act Provider Relief Fund FAQs.

Last week, HHS updated its CARES Act Provider Relief Fund Frequently Asked Questions (FAQs). The new or modified relevant FAQs are copied below. The largest change is the update of the FAQs to conform to the new deadline of 90 days to attest to the payment before HHS considers the provider to have (by default) attested by retaining the funds. The 5/29 changes have additional information warranting review.

What action does a provider need to take after receiving a Provider Relief Fund payment? (Modified 5/26/20)

The CARES Act requires that providers meet certain terms and conditions if a provider retains a Provider Relief Fund payment. If a provider chooses to retain the funds, it must attest that it meet these terms and conditions of the payment. The CARES Act Provider Relief Fund Payment Attestation Portal will guide you through the attestation process to accept or reject the funds. Not returning the payment within 90 days of receipt will be viewed as acceptance of the Terms and Conditions. A provider must attest for each of the Provider Relief Fund distributions received.

How can I return a payment I received under the Provider Relief Fund? (Modified 5/26/2020)

Providers may return a payment by going into the attestation portal within 90 days of receiving payment and indicating they are rejecting the funds. The CARES Act Provider Relief Fund Payment Attestation Portal will guide providers through the attestation process to reject the funds.

To return the money, the provider needs to contact their financial institution and ask the institution to refuse the received Automated Clearinghouse (ACH) credit by initiating an ACH return using the ACH return code of “R23 - Credit Entry Refused by Receiver." If a provider received the money via ACH they must return the money via ACH. If a provider was paid via paper check, after rejecting the payment in the attestation portal, the provider should destroy the check if not deposited or mail a paper check to UnitedHealth Group with notification of their request to return the funds.

Is there a publicly available list of providers and the payments they received through the Provider Relief Fund? (Modified 5/26/2020)

HHS has posted a public list of providers and their payments once they attest to receiving the money and agree to the Terms and Conditions. All providers that received a payment from the Provider Relief Fund and retain that payment for at least 90 days without rejecting the funds are deemed to have accepted the Terms and Conditions. Providers that affirmatively attest through the provider portal or that retain the funds past 90 days, but do not attest, will be included in the public release of providers and payments. The list includes current total amounts attested to by providers from each of the Provider Relief Fund distributions, including the General Distribution, Rural Distribution, and High-Impact Areas Distribution.

What should a provider do if a General Distribution payment is greater than expected or received in error? (Modified 5/26/2020)

Providers that have been allocated a payment must sign an attestation confirming receipt of the funds and agree to the Terms and Conditions within 90 days of payment. If a provider believes it was overpaid or may have received a payment in error, it should reject the entire General Distribution payment and submit the appropriate revenue documents through the General Distribution portal to facilitate HHS determining their correct payment. If a provider believes they are underpaid, they should accept the payment and submit their revenues in the provider portal to determine their correct payment.

If I changed my mind after I rejected a Provider Relief Fund Targeted Distribution payment through the Attestation Portal and returned the payment, can I receive a new payment? (Added 5/29/2020)

No, HHS will not issue a new payment to a provider that received and then subsequently rejected and returned the original payment. The provider may be considered for future distributions if it meets the eligibility criteria for that distribution.

What is the definition of Executive Level II pay level, as referenced in the Terms and Conditions? (Added 5/29/2020)

The Terms and Conditions state that none of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other mechanism, at a rate in excess of Executive Level II. The salary limitation is based upon the Executive Level II of the Federal Executive Pay Scale. Effective January 5, 2020, the Executive Level II salary is $197,300. For the purposes of the salary limitation, the direct salary is exclusive of fringe benefits and indirect costs. The limitation only applies to the rate of pay charged to Provider Relief Fund payments and other HHS awards. An organization receiving Provider Relief Funds may pay an individual’s salary amount in excess of the salary cap with non-federal funds.

Can providers who have ceased operation due to the COVID-19 pandemic still receive this funding? (Added 5/29/2020)

If a provider ceased operation as a result of the COVID-19 pandemic, they are still eligible to receive Provider Relief funds so long as they provided on or after January 31, 2020, diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. HHS broadly views every patient as a possible case of COVID-19, therefore, care does not have to be specific to treating COVID-19. Recipients of funding must still comply with the Terms and Conditions related to permissible uses of Provider Relief Fund payments.

If a provider secures COVID-19-related funding separate from the Provider Relief Fund, such as the Small Business Administration’s Paycheck Protection Program, does that affect how they can use the payments from the Provider Relief Fund? Does accepting Provider Relief Fund payments preclude a provider organization from seeking other funds authorized under the CARES Act? (Added 5/29/2020)

There is no direct ban under the CARES Act on accepting a payment from the Provider Relief Fund and other sources, so long as the payment from the Provider Relief Fund is used only for permissible purposes and the recipient complies with the Terms and Conditions. By attesting to the Terms and Conditions, the recipient certifies that it will not use the payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.

How will HHS recoup funds from providers that are required to repay all or part of a Provider Relief Fund payment? (Added 5/29/2020)

HHS has not yet detailed how recoupment or repayment will work. However, the Terms and Conditions associated with payment require that the Recipient be able to certify, among other requirements, that it was eligible to receive the funds (e.g., provides or provided after January 31, 2020, diagnoses, testing, or care for individuals with possible or actual cases of COVID-19) and that the funds were used in accordance with allowable purposes (e.g., to prevent, prepare for, and respond to coronavirus). Additionally, recipients must submit all required reports as determined by the Secretary. Non-compliance with any Term or Condition is grounds for the Secretary to direct recoupment of some or all of the payments made. HHS will have significant anti-fraud monitoring of the funds distributed, and the Office of Inspector General will provide oversight as required in the CARES Act to ensure that Federal dollars are used appropriately.

How is HHS publicly reporting Provider Relief Fund payments? Would it be accurate to add the payments received by a health care provider together based on the provider’s name in order to determine how much a particular organization has received as a whole? (Added 5/29/2020)

This approach may not be accurate. Each row in the public use file (PUF) is associated with an individual billing TIN, which is the unique identifier that received and attested to one or more payments. If an organization name is listed more than once, it may be because the organization has more than one billing TIN that received a payment, or it may be because multiple providers have the same name.

How did HHS determine the additional payments under the General Distribution? (Modified 5/29/20)

HHS is distributing an additional $20 billion of the General Distribution to providers to augment their initial allocation so that $50 billion is allocated proportional to providers' share of 2018 net patient revenue. The allocation methodology is designed to provide relief to providers, who bill Medicare fee-for-service, with at least 2% of that provider’s net patient revenue regardless of the provider’s payer mix. Payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April. If the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you may not receive additional General Distribution payments.

I am a healthcare provider that received a previous General Distribution payment and I submitted my revenue information through DocuSign. Why am I not receiving an additional payment? (Modified 5/29/2020)

HHS is distributing an additional $20 billion of the General Distribution to providers to augment their initial allocation so that $50 billion is allocated proportional to providers' share of 2018 net patient revenue. Payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April. If the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you may not receive additional General Distribution payments. There may be additional distributions in the future for which providers are eligible.

How long does it take for HHS to make a decision on additional General Distribution funding? When can I expect to receive additional funds? (Modified 5/29/2020)

HHS is working to process all providers’ submissions as quickly as possible. HHS is distributing an additional $20 billion of the General Distribution to providers to augment their initial allocation so that $50 billion is allocated proportional to providers' share of 2018 net patient revenue. Payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April. If after further review of your resubmitted revenue information, the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you may not receive additional General Distribution payments. It is the Department’s intention to distribute relief funds as quickly as possible.

How will HHS notify me that my application has been processed? (Modified 5/29/2020)

You will receive an email when your application is completed. You will receive a notification from HHS as to the final status of your application. HHS is distributing an additional $20 billion of the General Distribution to providers to augment their initial allocation so that $50 billion is allocated proportional to providers' share of 2018 net patient revenue. Payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April. If after further review of your resubmitted revenue information, the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you may not receive additional General Distribution payments.

 

May 26, 2020

HHS Extends the Provider Relief Fund Compliance Deadline by 45 days
On May 22, the U.S. Department of Health and Human Services (HHS) announced a 45-day deadline extension for providers who are receiving payments from the Provider Relief Fund to accept the Terms and Conditions for Provider Relief Fund payments. Providers now have 90 days from the date they received a payment to accept HHS Terms and Conditions or return the funds.

All providers who have received Provider Relief Fund payments must agree to the Terms and Conditions, if they wish to keep the funds.

HHS previously announced that $50 billion of the Provider Relief Fund was allocated for general distribution to facilities and providers that bill Medicare and were impacted by COVID-19, based on eligible providers' net patient revenue. To expedite providers getting money as quickly as possible, HHS distributed $30 billion immediately, proportionate to providers' share of Medicare fee-for-service reimbursements in 2019. Then, beginning on April 24, HHS began distributing an additional $20 billion to providers based on their share of net patient revenue, and began accepting submissions from eligible providers of their financial data.

Providers will now have 90 days from the date they received a payment to accept the Terms and Conditions or return the funds. Providers that do not accept the Terms and Conditions after 90 days of receipt will be deemed to have accepted the Terms and Conditions.

Visit hhs.gov/providerrelief for more information.

SBA and Treasury Issue Rule on PPP Loan Forgiveness
On May 22, the Small Business Administration (SBA), in consultation with the Department of the Treasury, issued an interim final rule (IFR) related to loan forgiveness for the Paycheck Protection Program (PPP). The IFR retains the requirement that 75% of loan proceeds be used for payroll costs to receive full loan repayment, which has been a point of contention for the business community and may be repealed by Congress in the Paycheck Protection Program Flexibility Act. However, the SBA provides several other key clarifications to assist small business owners.

  • Since payroll cycles may not align neatly with the eight-week period eligible for forgiveness, the IFR provides flexibility to borrowers with bi-weekly or more frequent payroll cycles, by allowing them to use an alternative payroll covered period.
  • Clarifies that certain nonpayroll costs incurred during the eight weeks, but paid by the next regular billing date, will still be eligible for forgiveness even if that billing date falls outside the covered period.

SBA also provides several key clarifications related to reductions in loan forgiveness amounts.

  • Allows for full loan forgiveness, if employees are rehired or salary levels are reestablished on or before June 30.
  • No “double penalty” in that any loan forgiveness reductions due to changes in number of employees will not be not counted toward any reductions related to changes in salary.
  • Establishes the exact process a borrower must follow to avoid a reduction in forgiveness for employees who reject rehiring offers.
  • Provides leniency for employers as it relates to employees who are fired for cause, or voluntarily resign or request a reduced schedule.

SBA clarifies that, for purposes of the PPP, a “full-time equivalent employee” means an employee who works 40 hours or more on average each week and provides two options for how to calculate employees who were paid for less than 40 hours per week. In addition, the IFR reaffirms the 60 days for the lender to review the loan forgiveness application and 90 days for the SBA to respond, clarifies that payroll costs are broadly defined as well as denoting payroll compensation for owner-employees and self-employed individuals, and provides additional information on loan forgiveness documentation.

May 20, 2020

Providers Must Act by June 3, 2020 to Receive Additional Relief Fund General Distribution Payment

Today, May 20, the U.S. Department of Health and Human Services (HHS) is reminding eligible providers that they have until June 3, 2020, to accept the Terms and Conditions and submit their revenue information to support receiving an additional payment from the Provider Relief Fund $50 billion General Distribution. All providers who automatically received an additional General Distribution payment prior to 5:00 pm, Friday, April 24th, must provide HHS with an accounting of their annual revenues by submitting tax forms or financial statements. These providers must also agree to the program Terms and Conditions if they wish to keep the funds. Providers who have cases pending before the department for adjudication with regard to eligibility for general distribution funding will not be impacted by this closure. All cases needing individual adjudication will need to be received by HHS no later than June 3, 2020.

The submission of tax forms or financial statements to the portal will also serve as an application for additional funding for those providers that have not already received an additional General Distribution payment. If these providers do not submit their revenue information by June 3, they will no longer be eligible to receive potential additional funding from the $50 billion General Distribution.

As you are aware, HHS previously announced $50 billion of the Provider Relief Fund was allocated for general distribution to facilities and providers that bill Medicare and were impacted by COVID-19, based on eligible providers' net patient revenue. To expedite providers getting money as quickly as possible, HHS distributed $30 billion immediately, proportionate to providers' share of Medicare fee-for-service reimbursements in 2019. Then, beginning on April 24, HHS began distributing an additional $20 billion to providers based on their share of net patient revenue, and began accepting submissions from eligible providers of their financial data. Providers have 45 days from the date they received a payment to attest and accept the Terms and Conditions or return the funds. Providers that do not log into the provider portal and accept the Terms and Conditions after 45 days of receipt will be deemed to have accepted the Terms and Conditions.

Visit here for more information.

HHS Updates the Provider Relief Fund FAQs

On May 19, updated the Provider Relief Fund FAQs. New/modified questions are below:

What should a provider do if a General Distribution payment is greater than expected or received in error? (Modified 5/19/2020)

Providers that have been allocated a payment must sign an attestation confirming receipt of the funds and agree to the Terms and Conditions within 45 days of payment. If a provider believes it was overpaid or may have received a payment in error, it should reject the entire General Distribution payment and submit the appropriate revenue documents through the General Distribution portal to facilitate HHS determining their correct payment. If a provider believes they are underpaid, they should accept the payment and submit their revenues in the provider portal to determine their correct payment.

If, as a result of the sale of a practice/hospital, the TIN that received a General Distribution payment is no longer providing health care services as of January 31, 2020, is it required to return the General Distribution payment? (Added 5/19/2020)

Yes. If, as a result of the sale of a practice/hospital, the TIN that received a General Distribution payment did not provide diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 on or after January 31, 2020, the provider must reject the payment. The CARES Act Provider Relief Fund Payment Attestation Portal will guide you through the attestation process to reject the payment.

An organization purchased a practice during or after the year of the organization’s most recent tax filing and the purchased practice’s revenues are not reflected in the most recent tax return. How does the organization account for these acquisitions when submitting revenue information in the Payment Portal? (Added 5/19/2020)

An organization’s adjusted gross receipts should be calculated as gross receipts as shown on the organization’s most recent tax return plus gross receipts of the practice acquired not reflected in the organization’s tax return minus gross receipts of providers sold not reflected in the organization’s tax return. If an organization’s adjusted gross receipts exceed the gross receipts shown in the tax return by more than 20%, the organization is eligible to enter the adjusted gross receipts figure in the Provider Relief Fund Payment Portal. Otherwise, the organization should enter the gross receipts figure as shown on the tax return. Organizations that have already submitted an application in the Payment Portal can resubmit a revised application using the adjusted gross receipts number accounting for acquisitions, if the adjusted gross receipts exceeds the gross receipts shown in the tax return by more than 20%. Gross receipts of acquired entities that provide care as of January 31, 2020 and file their own tax returns cannot be included in such adjusted gross receipts figure, because they should submit their own application as tax return filers.

Can an organization that sold its only practice or facility under a change in ownership in 2019 and is no longer providing services, accept payment and transfer it to the new owner? (Added 5/19/2020)

No. A provider that sold its only practice or facility must reject the Provider Relief Fund payment because it cannot attest that it was providing diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 on or after January 31, 2020, as required by the Terms and Conditions. Seller organizations should not transfer a payment received from HHS to another entity. If the current TIN owner has not yet received any payment from the Provider Relief Fund, it may still receive funds in other distributions.

Can a provider that purchased a TIN in 2019 accept a Provider Relief Fund payment from a previous owner and complete the attestation for the Terms and Conditions? (Added 5/19/2020)

No. The new TIN owner cannot accept the payment from another entity nor attest to the Terms and Conditions on behalf of the previous owner in order to retain the Provider Relief Fund payment. If the new TIN owner did not receive a direct payment under the General Distribution, it is not eligible to receive a payment under the General Distribution. However, the new TIN owner may still receive funds in other distributions.

Should providers continue to update their high-impact data? (Modified 5/19/2020)

Providers should update their capacity and COVID-19 census data to ensure that HHS can make timely payments in the event that the provider becomes a high-impact provider. Providers can continue to update their information through the same method they used previously.

May 19, 2020

HHS Provides Additional Clarification - Provider Relief Fund
As you are aware, HHS has asked for practices to provide documentation of certain revenue information so that it can make the calculations for the provider relief funds specific to each TIN (Taxpayer Identification Number). HHS removed the formula and overpayments language from the portal last week to address concerns from physicians who had done their own estimates and reached conclusions about potential overpayments instead of relying on HHS to do the calculations. Unfortunately, in some cases these changes with formulas appearing and disappearing from the website heightened rather than allayed concerns.

On Friday, May 15th, HHS posted revised FAQs on the Provider Relief Fund General Distribution Portal.

Several of the FAQs are dated May 14th, and seek to clarify some of the recent confusion, particularly these two questions:

How did HHS determine the additional payments under the General Distribution? (Added 5/14/2020)

HHS is distributing an additional $20 billion of the General Distribution to providers to augment their initial allocation so that $50 billion is allocated proportional to providers' share of 2018 net patient revenue. The allocation methodology is designed to provide relief to providers, who bill Medicare fee-for-service, with at least 2% of that provider’s net patient revenue regardless of the provider’s payer mix. Payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April. If the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you will not receive additional General Distribution payments.

How can I estimate 2% of patient revenue to determine my approximate General Distribution payment? (Added 5/14/2020)

In general, providers can estimate payments from the General Distribution of approximately 2% of 2018 (or most recent complete tax year) patient revenue. To estimate your payment, use this equation:

(Individual Provider Revenues/$2.5 Trillion) X $50 Billion = Expected Combined General Distribution

To estimate your payment, you may need to use “Gross Receipts or Sales” or “Program Service Revenue.” Providers should work with a tax professional for accurate submission.

This includes any payments under the first $30 billion general distribution, as well as under the $20 billion general distribution allocations. Providers may not receive a second distribution payment if the provider received a first distribution payment of equal to or more than 2% of patient revenue.

May 18, 2020

SBA Releases Paycheck Protection Program (PPP) Loan Forgiveness Application
On May 15, the Small Business Administration (SBA), in consultation with the Department of the Treasury, released the PPP Loan Forgiveness Application, as well as detailed instructions. SBA is also expected to issue regulations and guidance to further assist borrowers and to provide lenders with guidance on their responsibilities.

The form and instructions include:

  • Options for borrowers to calculate payroll costs using an “alternative payroll covered period” that aligns with borrowers’ regular payroll cycles
  • Flexibility to include eligible payroll and non-payroll expenses paid or incurred during the eight-week period after receiving their PPP loan
  • Step-by-step instructions on how to perform the calculations required by the CARES Act to confirm eligibility for loan forgiveness
  • Borrower-friendly implementation of statutory exemptions from loan forgiveness reduction based on rehiring by June 30
  • Addition of a new exemption from the loan forgiveness reduction for borrowers who have made a good-faith, written offer to rehire workers that was declined

Click here to view the application and instructions.

House Passes HEROES Act to Spur Negotiations
On May 15, the House of Representatives passed a $3 trillion COVID-19 relief bill, (H.R. 6800, the Health and Economic Recovery Omnibus Emergency Solutions Act or the HEROES Act) by a vote of 208-199. The bill is opposed by Republicans, and the White House has issued a veto threat.

The Democrats plan to use the bill as an opening bid for eventual negotiations with the Republican Senate and the Administration. It has been reported that Senate Majority Leader McConnell (R-KY) has indicated he does not plan on moving the next relief package until June at the earliest.

May 4, 2020

Update to CARES Provider Relief Fund Attestation
HHS has clarified that the total distribution for a provider from the Provider Relief Fund should be approximately 2% of 2018 gross revenue, based on the following:

To calculate your estimated total allocation, divide your "Gross Receipts or Sales" or "Program Service Revenue" by 2.5 trillion and then multiply by 50 billion. ((Gross Receipts or Sales) / 2,500,000,000,000) * 50,000,000,000)

To determine whether a provider will likely receive additional funding from the $20 Billion, a provider should examine its 2018 gross patient revenue, as detailed below.

  • If the provider received less than 2% of 2018 gross revenue from the initial $30 billion distribution, then the provider may be eligible to receive additional funding up to the 2% calculation.
  • If the distribution from the initial $30 billion is more than 2% of 2018 gross revenue, then the provider will likely need to contact the CARES Provider Relief hotline to determine next steps.
  • Note that this calculation should be done for all TINs tied to 2018 net patient revenue amount.

Further, HHS has stated that the “names of payment recipients and the amounts received” will be publicly available for “all providers who attest to receipt of a payment and acceptance of the Terms and Conditions.” HHS further notes that a provider should not attest unless the payment is consistent with the estimated allocation.

To estimate the amount likely to be received via this portal application, subtract the amount of payments already received from your total estimated total allocation above.

Please do not attest if the payments you have received already exceed your estimated total allocation. Please contact the CARES Provider Relief hotline at (866) 569-3522 if you believe that you have received an overpayment.

Addendum to ASCRS ASOA Tele-Ophthalmology Guide Including all COVID-19 Telemedicine Changes The ASCRS ASOA Telemedicine Task Force has developed an addendum to the Introduction to Tele-Ophthalmology Guide, which reflects all the telemedicine coverage and reimbursement changes due to the pandemic.
The ASCRS ASOA Telemedicine Task Force has developed an addendum to the Introduction to Tele-Ophthalmology Guide, which reflects all the telemedicine coverage and reimbursement changes due to the pandemic

April 30, 2020

Centers for Medicare and Medicaid Services (CMS) Issues Second Round of Regulatory Waivers and Rule Changes Including Additional Flexibilities for Telehealth
On April 30th, CMS released the Interim Final Rule with Comment titled “Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program,” along with announcing additional flexibilities, including the continuation of efforts to further expand Medicare beneficiaries’ access to telehealth services.

These changes include:

  • Increasing payments for audio-only telephone visits to match payments for similar office and outpatient visits (currently from a range of about $14 - $41 to about $46 - $110) retroactive to March 1.
  • Waiving the video requirement for certain telephone evaluation and management services and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services.

Additional materials are available at these links:

 

April 27, 2020

CMS Announces Suspension of the Advance Payment Program
On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending the program to Part B suppliers effective immediately. The agency paid over $100 billion to healthcare providers and suppliers through this program, which was expanded on March 28. CMS will not be accepting any new applications, and CMS will be reevaluating all pending and new applications considering the direct payments being made through the Provider Relief Fund.

For an updated fact sheet on the Accelerated and Advance Payment Programs, click here.

For more information on the CARES Act Provider Relief Fund and how to apply, visit here.

CARES Provider Relief Fund Payment Portal is Now Open
Last week, the Department of Health and Human Services (HHS) announced additional plans for distributing funds from the CARES Act Provider Relief Fund and stated that $50 billion would be a “General Distribution” based proportionately on the provider’s 2018 net patient revenue. HHS would like the “General Distribution” to replace a percentage of a provider’s annual gross receipts, sales, or program service revenue.

Of that $50 billion, $30 billion has already been distributed to providers, and approximately $10 billion was scheduled to be released on April 24 to providers who have already shared key data with HHS. For those that received funds from the initial $30 billion and would like to receive additional funds, you must sign into the General Distribution Portal to provide revenue data. Providers must attest to each payment associated with their billing Taxpayer Identification Number(s) if they have not already done so. Providers will also need to attest to the Terms and Conditions for the first $30 billion, if not done already. At this time, this portal is only for organizations that have already received payments through the CARES Act Provider Relief Fund. Initially, some states and specialties thought that physicians must also submit cost reports, but HHS has verified this is not the case. Physicians, however, do need to submit their revenue information so that it can be verified through the portal. HHS has released a user guide to assist with this data submission process. One key element of the cost reporting is information from your tax returns. In addition, you will need your W-9 and Medicare or Medicaid ID number.

HHS will use this data to calculate your proportional 2018 net revenue and provide such funds via electronic deposit, with the goal of such deposit within 10 business days of the submission. Payments will go out weekly, on a rolling basis, as information is validated. HHS has stated that they will be processing applications in batches every Wednesday at 12:00 noon EDT. Funds will NOT be disbursed on a first-come-first-served basis; therefore, an applicant will be given equal consideration regardless of when they apply.

The total funds being provided in this round will consider any funds the provider previously received as part of the $30 billion distribution. Subsequent to the funds being deposited, within 30 days of receipt of the funds, a provider is requested to log onto the CARES Act Provider Relief Fund attestation portal to confirm receipt and agree to the Terms and Conditions(Note: These Terms and Conditions are NOT identical to those for the $30 billion distribution.)

If a provider meets certain Terms and Conditions, the payments received do not need to be repaid. These Terms and Conditions can be found here.

For more information, please visit here or call the CARES Provider Relief line at (866) 569-3522.

The AMA has put together guidance to help physicians pull together the information they need to submit to the portal. Also, here is additional information from HHS regarding the distribution.

The Department of Health and Human Services (HHS) posted new Frequently Asked Questions regarding this second round of disbursements. Please note there is conflicting information about whether a provider who hasn’t previously received money from the first round of funding can apply for this round. The medical community is working to get clarification on this and other questions with HHS.

April 23, 2020

Interim Relief COVID (3.5) Legislation Replenishing the Paycheck Protection Program (PPP) Passes the Senate; House Passage Imminent
On April 21, the Senate passed by unanimous consent, H.R. 266, the “Paycheck Protection Program and Health Care Enhancement Act." The legislation includes:

  • $310 billion in additional funding for the PPP
  • $75 billion in additional funding for the Public Health and Social Services Emergency Fund (health care providers)
  • $60 billion in separate disaster loans to small businesses
  • $25 billion for COVID-testing The House of Representatives began considering the legislation this afternoon and it is expected to pass.

The President will sign the bill immediately following House approval. This package is meant to provide interim relief. The Congress and Administration are expected to begin negotiations on the next, larger package – Phase 4.
 

Department of Health and Human Services (HHS) Provides Additional Information Regarding Allocation of the Remaining $70 Billion in the CARES Act Provider Relief Fund
As you are aware, on April 10, an initial $30 billion was allocated from the $100 billion to clinicians and facilities based on their proportion of Medicare Part A and B fee-for-service spending in 2019. HHS is now adding an additional $20 billion to this amount for what it describes as a $50 billion “general allocation.” The remaining fund distribution will be based on 2018 net patient revenue, not just Medicare fee-for-service.

Some portion of this distribution is based on cost reports, which are filed with HHS by hospitals and some other facilities. For those without adequate cost reports on file, HHS will open a portal this week for providers to attest to their net 2018 revenue for purposes of determining allocation. The medical community is seeking more information about how the additional funds will be allocated to physicians, including whether physicians will need to use this portal process to receive additional funds.

Of the remaining $50 billion:

  • $10 billion will be allocated for a targeted distribution to hospitals in areas that have been particularly impacted by the COVID-19 outbreak based on information they provide on the number of ICU beds and admissions for patients with a COVID-19 diagnosis.
  • $10 billion is being allocated to rural hospitals and rural health clinics based on their operating expenses, and
  • $400 million is being directed to Indian Health Service facilities.

Some portion of the remaining funds is being used to cover the costs of caring for uninsured patients with COVID-19. These funds may be claimed beginning April 27th at this location. Reimbursement for the uninsured will be based on Medicare payment rates. Physician services provided to uninsured patients, such as office and emergency visits, including those provided via telehealth, may be reimbursed in this manner.

An unspecified portion of the remaining funding will be used for clinicians, such as obstetrician-gynecologists, and facilities that rely more on Medicaid than Medicare revenues.

This updated information is available here. Updated details will be provided as soon as they are available.

HHS Releases Additional Changes to the Terms and Conditions for the PHSSEF
On April 20, HHS again, released an updated set of Terms and Conditions related to the release of the funding from the PHSSEF. As you are aware, they also made changes from their original Terms and Conditions on April 13.
Key changes in this document are as follows: 

HHS has added the following language at the beginning of the document: 

Acceptance of Terms and Conditions 

If you receive a payment from funds appropriated in the Public Health and Social Services Emergency Fund for provider relief (“Relief Fund”) under Division B of Public Law 116-127 and retain that payment for at least 30 days without contacting HHS regarding remittance of those funds, you are deemed to have accepted the following Terms and Conditions. Please also indicate your acceptance below. This is not an exhaustive list and you must comply with any other relevant statutes and regulations, as applicable. 

Your commitment to full compliance with all Terms and Conditions is material to the Secretary’s decision to disburse these funds to you. Non-compliance with any Term or Condition is grounds for the Secretary to recoup some or all of the payment made from the Relief Fund. 

These Terms and Conditions apply directly to the recipient of payment from the Relief Fund. In general, the requirements that apply to the recipient, also apply to subrecipients and contractors under grants, unless an exception is specified. 
 

HHS has updated the balance billing provision:

Previous language: "Accordingly, for all care for a possible or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient." (Emphasis added.)

Updated language: "Accordingly, for all care for a presumptive or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient." (Emphasis added.)

View the updated terms and conditions at this link
 

READY, SET, GO! REOPENING YOUR ASC IN THE WAKE OF COVID-19
After weeks of temporary closure or restricted operations, ASCs are looking to the future and anticipate re-opening at the earliest possible opportunity. There are many questions around the process of re-opening. While specific state guidance may vary, there are many steps necessary to assure compliance and staff and patient safety. ASOA members are invited to attend a webinar presented by Debra Stinchcomb and Nancy Stephens with Progressive Surgical Solutions, a division of BSM Consulting. This webinar will review essential actions in the areas of physical plant, Life Safety Code, clinical operations, infection control, finance/business operations, governance and more. A comprehensive Re-Opening Checklist will be provided to each registrant. Why waste time trying to reinvent the wheel or risk overlooking important considerations in the process? Do not miss this important and timely webinar.

Monday, May 4th
2 PM ET
Regular price: $75 ASOA Member Price - $50 with promo code OPENASC

More details here

Resuming Your Practice….A Digital Journey of Discovery to Help Restore
ASOA, in partnership with BSM Consulting, has developed a multi-part educational webinar series devoted to those issues facing practices as they begin to re-open and resume operations which will begin in May. Topics include change management, immediate relief funding and long term initiatives, financial planning, resuming operations (3-parts), and revenue enhancements. ASOA Annual Meeting attendee favorite, Joe Mull, will close the series with a presentation on Team Recovery: What Employees Need from Bosses to Re-Open, Come Together, and Start Again. Watch for pricing and schedule information coming next soon.

 

April 20, 2020

CMS Releases Recommendations to Re-Open Health Care Facilities to Provide Non-Emergent Care, Including Elective Surgeries
On April 19th, CMS released recommendations to re-open health care facilities to provide non-emergent care, including elective surgeries. The recommendations state that non-COVID care should be offered as clinically appropriate if the state, locality, or facility has resources to provide such care and the ability to quickly respond to a surge in COVID-19, if necessary. Learn more...

American College of Surgeons (ACS), American Hospital Association (AHA), American Society of Anesthesiologists (ASA), Association of periOperative Registered Nurses (AORN) Release Roadmap for Resuming Elective Procedures and Surgeries
On April 17th, ACS, AHA, ASA, and AORN released a joint statement outlining principles and conditions for resuming elective surgery and other procedures.

The timing for resuming elective surgery is one of the eight principles and considerations to guide physicians, nurses and facilities in their resumption of elective surgery care, for operating rooms and all procedural areas, factoring in: timing, testing, adequate equipment, prioritization and scheduling, data collection and management, COVID-related safety and risk mitigation surrounding a second wave and other issues including the mental health of health care workers, patient communications, environmental cleaning and regulatory issues.
 

April 16, 2020

Tele-Ophthalmology

Introduction to Tele-Ophthalmology
Expanded Medicare telehealth coverage enables beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. ASCRS and ASOA have prepared a guide to starting your practice on the tele-ophthalmology path. Learn more...

WEBINAR - Updated: Implementing Tele-Ophthalmology During the COVID-19 Pandemic
Recent government action has expanded telehealth coverage for Medicare beneficiaries nationwide, temporarily waiving penalties for HIPAA violations, and will reimburse physicians for telehealth services at the same rate for face-to-face services. CMS recently announced additional policies, including Medicare coverage for telephone services, and significant additions to the list of covered telehealth services, such as emergency visits. ASCRS and ASOA recognize that our members need resources on how to implement telemedicine visits for their practices and patients. Watch the webinar replay... 

Physician Relief Provisions in the CARES Act

Coronavirus Aid, Relief, and Economic Security (CARES) Act – Key Physician – Related Provisions
ASCRS and the surgical community lobbied for specific provisions included within the CARES Act that provides relief for ASCRS members and their practices. The key physician-related provisions are highlighted in the ASCRS/ASOA Phase III document.

In addition, the congressional staff prepared an FAQ document on the CARES Act.

Advance Payment Program

CMS Announcement of Expansion of Accelerated and Advance Payment Program
On March 28th, CMS announced an expansion of its accelerated and advance payment program for Medicare participating providers and suppliers due to the financial hardships and challenges providers are facing as a result of the COVID-19 pandemic. CMS specifically highlights the disruption to the health care industry, including the delay of non-essential surgeries and procedures and the disruption to billing.

Accelerated and advance Medicare payments, which are typically offered in natural disasters, provide emergency funding and addresses cash flow issues based on historical payments when there is a disruption in claims submission and/or claims processing. Due to the pandemic, CMS is expanding the program for all Medicare providers throughout the country during this public health emergency. The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers. Learn more…

Medicare's COVID-19 Advanced Payment Program: Frequently Asked Questions
As a result of the quick rollout of the program, there are many questions regarding the procedure to apply for and obtain the funds, as well as the timeline and specifics for recoupment.

Recently, the AMA met with CMS senior officials to raise these questions. Here are the answers provided by CMS. We will continue to work with the AMA, the medical community, and CMS to improve the program – including extending the timelines and waiving the interest if loan not recouped in 210 days.

WEBINAR - MEDICARE’s COVID-19 Advance Payment Program: Frequently Asked Questions
The CARES Act provided the Centers for Medicare and Medicaid Services (CMS) with expanded authority to make available advance payments to physicians to assist during the COVID-19 emergency. As a result of the quick rollout of the program, there are many questions regarding the procedure to apply for and obtain the funds, as well as the timeline and specifics for recoupment. Recently, the AMA met with CMS senior officials to raise these questions, many of them provided to the AMA by ASCRS and ASOA. Join Nancey McCann, ASCRS Director of Government Relations, for a review of the answers. Watch the webinar replay... 

Public Health Emergency Fund Grants

HHS Clarifies Terms and Conditions of Emergency Fund Grants; Providers are Eligible for Grants – Even if You are Not Directly Providing Care to COVID-19 Patients
After ASCRS, the AMA and other medical organizations raised concerns when the initial HHS Emergency Fund grants were released that, 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, 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. Providers are eligible, even if they are not directly providing care to COVID-19 patients.

The website at CARES Act Provider Relief Fund 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 1/31/2020:

The Recipient certifies that it billed Medicare in 2019; provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19; is not currently terminated from participation in Medicare; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently have Medicare billing privileges revoked.

Provider Relief Fund Payment Attestation Portal Now Open
The CARES Act Provider Relief Fund Payment Attestation Portal is now open. Providers who have been allocated a payment from the initial $30 billion general distribution must sign an attestation confirming receipt of the funds and agree to the terms and conditions within 30 days of payment.

The portal has a variety of steps, including confirmation of eligibility, billing TINs, verifying payment information, attestations (likely related to the Terms and Conditions), and confirmation.

As a reminder, HHS' payment of this first round of payments is conditioned on the healthcare provider's acceptance of the Terms and Conditions, which acceptance must occur within 30 days of receipt of payment. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions. The portal will guide providers through the attestation process to accept or reject the funds.

Verifying Eligibility for Payment and Contact Information
Since last Friday when HHS announced it would begin disbursing the first $30 million of the emergency fund created under the Coronavirus Aid, Relief, and Economic Security (CARES) Act to physicians and other providers via direct payment, there have been questions about how to verify eligibility for payment and who to contact when a physician believes they are eligible but did not receive a payment. HHS partnered with UnitedHealth Group (UHG) to deliver the stimulus payments, and physicians should contact UHG’s Provider Relations at 866-569-3522 about eligibility, whether a payment has been issued, and where it was sent. Note, if a physician or practice did not already set up direct deposit through CMS or UHG’s Optum Pay, they will receive a check at a later date. Practices that would like to set up direct deposit now can call the UHG Provider Relations number. 

Paycheck Protection Program (PPP)

Department of the Treasury Guidance Regarding the Paycheck Protection Program (PPP)
Department of Treasury information fact sheet on the PPP, which authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the pandemic.

Quality Reporting/MIPS

CMS Delays 2019 MIPS Submission Deadline to April 30, 2020, Adds Hardship Exception for COVID-19; Provides Relief for 2019 Fourth Quarter ASC Quality Reporting
On March 22, 2020, CMS announced it would extend the deadline to submit 2019 MIPS data until April 30, 2020. In addition, CMS created a new extreme and uncontrollable circumstances hardship policy so that any physician or group who fails to report 2019 MIPS data by April 30, 2020 will receive a neutral payment adjustment in 2021. CMS is also evaluating options for providing relief for the 2020 MIPS performance year.

Physicians who have not submitted any MIPS data by April 30, 2020 do not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. These clinicians will be automatically identified and receive a neutral payment adjustment for the 2021 MIPS payment year. All four MIPS performance categories for these clinicians will be weighted at zero percent, resulting in a score equal to the performance threshold, and a neutral MIPS payment adjustment for the 2021 MIPS payment year. However, if a MIPS eligible clinician submits data on two or more MIPS performance categories, they will be scored and receive a 2021 MIPS payment adjustment based on their 2019 MIPS final score. Learn more…  

First Coronavirus Response Act (FFCRA)

Paid Sick and Family Leave Tax Credits – FAQ’s
The US Department of the Treasury and the IRS released guidance for small and mid-size employers regarding refundable tax credits that reimburse them for the cost of providing their employees paid sick and family leave wages related to COVID-19. The Families First Coronavirus Response Act (FFCRA) gives businesses with fewer than 500 employees funds to provide employees with paid sick leave and family and medical leave related to the pandemic.

  • Eligible employers can receive a credit in the full amount of the qualified sick leave and family leave wages paid for between April 1, 2020 and December 31, 2020
  • Employers can be reimbursed immediately by reducing their federal employment tax deposits. If there are insufficient federal employment taxes to cover the amount of the credits, employers may request an accelerated payment from the IRS

Read more information on small and mid-size business tax credits for paid sick and family leave. 
 

April 10, 2020

The Department of Health and Human Services (HHS) Begins Immediate Disbursement of $30 Billion in Grants to Medicare Providers
This morning, HHS announced the immediate disbursement of the first $30 billion out of the $100 billion that Congress allocated to hospitals, physicians and other health care providers in the Public Health and Social Services Emergency Fund that was included in the Coronavirus Aid, Relief and Economic Security (CARES) Act. ASCRS joined the AMA and the medical community in advocating for these funds and assuring that physicians were included.

This initial $30 billion, which is being distributed immediately through direct deposit beginning today, is being directed to facilities and physician practices in direct proportion to their share of Medicare fee-for-service spending. The total amount of Medicare FFS spending in 2019 was $484 billion. Hypothetically, if a Medicare provider with a Taxpayer ID Number (TIN) accounted for 1% of total Medicare FFS spending in 2019, the TIN would receive 1% of the $30 billion.

All facilities and health professionals that billed Medicare FFS in 2019 are eligible for the funds. These are grants, not loans, and do not have to be repaid. Note that the funds will go to each organization's TIN which normally receives Medicare payments, not to each individual physician. The automatic payments will come to the organizations via Optum Bank with "HHSPAYMENT" as the payment description.

Additional details about the allocation are available here.

This website also includes a link to Terms and Conditions for receipt of the funds that each organization receiving the grants will need to attest to within 30 days of receiving the grant. The funds may be used either for health care related expenses or for lost revenues that are attributable to coronavirus.

Due to some conflicting information included in the Terms and Conditions regarding the requirement to certify that you “diagnose, treat, and test for COVID-19,” ASCRS is working to get clarification. We will include additional details in today’s edition of the Washington Watch. We advise you to carefully read the terms and conditions provided.

April 2, 2020

MEDICARE’S COVID-19 ADVANCE PAYMENT PROGRAM - Frequently Asked Questions
The CARES Act provided the Centers for Medicare and Medicaid Services (CMS) with expanded authority to make available advance payments to physicians to assist during the COVID-19 emergency. As a result of the quick rollout of the program, there are many questions regarding the procedure to apply for and obtain the funds, as well as the timeline and specifics for recoupment.

Recently, the AMA met with CMS senior officials to raise these questions. Here are the answers provided by CMS. We will continue to work with the AMA, the medical community, and CMS to improve the program.

Upcoming Webinars
ASCRS and ASOA will be hosting several webinars for our members beginning next week. Topics covered will include updated information on telemedicine, the advance payment program, small business loans, Families First Coronavirus Response Act, and the Payroll Payment Protection program. Watch for additional information coming soon.

Please submit any questions you have regarding any of these topics to asoa@asoa.org no later than close of business Tuesday, April 7th. Please Note: Questions must be general in nature and not practice specific. Practices should consult their financial and legal professionals for those types of questions.

April 1, 2020

Department of the Treasury and the Internal Revenue Service (IRS) Release FAQs to Help Navigate Paid Sick and Family Leave Tax Credits
Earlier today, the US Department of the Treasury and the IRS released guidance for small and mid-size employers regarding refundable tax credits that reimburse them for the cost of providing their employees paid sick and family leave wages related to COVID-19.  The Families First Coronavirus Response Act (FFCRA) gives businesses with fewer than 500 employees funds to provide employees with paid sick leave and family and medical leave related to the pandemic.

•    Eligible employers can receive a credit in the full amount of the qualified sick leave and family leave wages paid for between April 1, 2020 and December 31, 2020.
•    Employers can be reimbursed immediately by reducing their federal employment tax deposits.  If there are insufficient federal employment taxes to cover the amount of the credits, employers may request an accelerated payment from the IRS.

Read more information on small and mid-size business tax credits for paid sick and family leave. 

Department of the Treasury Releases Guidance Regarding the Paycheck Protection Program (PPP)
Yesterday, the Department of Treasury released an information fact sheet on the PPP, which authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the pandemic.

CMS Clarification on Advance Payment Interest
During a meeting with the AMA yesterday, CMS confirmed there’s no fee or interest for the advance payment during the 210 days after the advance, including the 120 days before recoupment begins and during the 90-day recoupment. Interest does start if there’s still debt after that timeline and the physician enters into an extended repayment process. The interest is set at a statutory rate, which is 10.25% right now. CMS is talking to its counsel about any flexibility they have, but the medical community may have to go to Congress.

We expect the AMA to release further guidance on this issue – as well as others that were raised in their meeting, and we will provide the information to you when available.
 

March 31, 2020

Centers for Medicare and Medicaid Services (CMS) Announces New Policies to Help Physicians and Hospitals During COVID-19
Late yesterday, CMS released a number of new policies to help physicians and hospitals during the pandemic.  These actions include:  Medicare coverage for telephone services, significant additions to the list of covered telehealth services, such as emergency visits, greater clarity on the use of remote patient monitoring for acute conditions like the virus and allowing Ambulatory Surgery Centers to contract with local healthcare systems to provide hospital services.  

Providers will be able to evaluate beneficiaries via auto phones and bill for telehealth visits at the same rate as in-person visits.  This includes new, as well as established patients.  In addition, ASCs can enroll and bill as hospitals during the emergency and will be able to offer services, such as trauma and essential surgeries as well as cancer procedures.  CMS is also providing temporary relief from many audit and reporting requirements by extending deadlines and suspending documentation requests.

Below are the links to a CMS fact sheet, as well as the CMS press release:

Fact Sheet

Press Release
 

Accelerated and Advance Medicare Payments
Recently, CMS announced an expansion of its accelerated and advance payment program for Medicare-participating providers and suppliers. To clarify, payment requests can be up to 100% of three months based on historical claims data, and CMS requests a "good faith" estimate.  The recoupment begins four months after the advanced payment is allocated.  From then on, claims will be automatically reduced to repay the advanced amount for up to 90 days.  We have heard that carriers are telling providers that a high interest rate will be applied after the 90 days.  We are working to get clarification – because it was our understanding that there would be no interest.

As a reminder, to qualify for these payments, the provider must:

  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider's form,
  • Not be in bankruptcy.
  • Not be under active medical review or program integrity investigation, and
  • Not have any outstanding delinquent Medicare payments.

We recommend that you contact your Medicare carrier to get additional information.

Information on the accelerated/advance payment process and how to submit a request form can be found here.

Coronavirus Aid, Relief, and Economic Security (CARES) Act – Key Physician – Related Provisions
ASCRS and the surgical community lobbied for specific provisions included within the CARES Act that provide relief for ASCRS members and their practices. The key physician-related provisions are highlighted in the ASCRS/ASOA Phase III document.

In addition, the congressional staff prepared an FAQ document on the CARES Act. ASCRS will be joining the American College of Surgeons and the surgical coalition in a letter to HHS requesting clarification on certain provisions and additional information. We will continue to keep you updated as additional details are released.

 

March 29, 2020

Centers for Medicare & Medicaid Services (CMS) Provides Financial Relief for Medicare Providers
On March 28th, CMS announced an expansion of its accelerated and advance payment program for Medicare participating providers and suppliers due to the financial hardships and challenges providers are facing as a result of the COVID-19 pandemic. CMS specifically highlights the disruption to the health care industry, including the delay of non-essential surgeries and procedures and the disruption to billing. 

Accelerated and advance Medicare payments, which are typically offered in natural disasters, provide emergency funding and addresses cash flow issues based on historical payments when there is a disruption in claims submission and/or claims processing. Due to the pandemic, CMS is expanding the program for all Medicare providers throughout the country during this public health emergency. The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers. 

To qualify for these 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 over payments. 

Medicare will start accepting and processing these requests immediately, and CMS anticipates that the payments will be issued within days of the provider’s request. 

Information on the accelerated/advance payment process and how to submit a request can be found here

If you have questions, please contact ASCRS Director of Government Relations Nancey McCann at nmccann@ascrs.org.   
 

March 27, 2020

DOL Issues Additional Guidance on the Families First Coronavirus Response Act
The Department of Labor issued updated guidance on March 26th for the Families First Coronavirus Response Act including two new posters, one for federal workers and one for all other employees that will fulfill notice requirements for employers obligated to inform employees about their rights under this new law.

Senate Passes Phase III (Stimulus Relief) of COVID-19 Legislation Package, House to Follow on Friday; President Expected to Sign into Law 
Wednesday night, the Senate passed H.R. 748, the “Coronavirus Aid, Relief, and Economic Security (CARES) Act,” phase 3 stimulus legislation of the Coronavirus relief packages.  Speaker Nancy Pelosi (D-CA) will bring the legislation to the House floor on Friday morning for a voice vote, which would not require the House’s 429 sitting members to reconvene in Washington. Once passed by the House, the bill will be sent to the President for his immediate signature.

ASCRS and the surgical community have lobbied for specific provisions included within this legislation that provide relief for ASCRS members and their practices.  The key physician-related provisions are highlighted in the ASCRS/ASOA Phase III document.

CMS COVID-19 News Alert
CMS has taken several recent actions in response to the Coronavirus Disease 2019 (COVID-19), as part of the ongoing White House Task Force efforts. A summary of recent CMS activities can be found here.

To keep up with the important work the Task Force is doing in response to COVID-19, click here. For information specific to CMS, please visit the CMS News Room and Current Emergencies Website.

BSM Webinar Series: Navigating Your Practice Through COVID-19
This four-part webinar series presented by BSM Consulting CEO and Founder, Bruce Maller, will offer business advice, helpful resources, and relevant tools to help practices navigate their business through the COVID-19 crisis. Regular price for the series is $199 and BSM is offering a discounted rate of $149 to ASOA members with dates and topics as follows:

March 30 – How to Use the Cash Flow Forecasting Tool
April 1 – Taking Advantage of New Legislative Initiatives
April 3 – Preserving the Integrity of Your Workforce
April 6 – Managing Relations with Landlords, Lenders, and Vendors

Click here to register using the code NAVIGATE to receive the discount.

BSM Consulting is an ASOA Platinum Strategic Business Partner.

March 24, 2020

ASCRS Advocates for Immediate Relief for Ophthalmologists In Wake of COVID-19 Pandemic
As part of its ongoing efforts to secure relief for physicians and their practices impacted by the COVID-19 pandemic, ASCRS recently joined colleagues in the surgical and specialty medical communities in two additional letters. The first, in conjunction with the Alliance of Specialty Medicine, urges Congress to ensure that physician practices qualify for financial relief, including loans and relief from payroll taxes as part of the Small Business provisions. The second letter, sent in conjunction with the Surgical Coalition, issues support for the Immediate Relief for Rural Facilities and Providers Act, which would provide an emergency, one-time grant for all providers and ambulatory surgery centers equal to their total payroll from January 1 - April 1, 2019 and authorize the Small Business Administration to provide low interest loans to providers and ambulatory surgery centers at a 0.25% interest rate that will not accrue until two years after the COVID-19 pandemic has ended. We issued support for this bill with the intention that its provisions be included in the third stimulus package currently in development.

You can learn more and review all letters under ASCRS Advocacy Resources.
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Earlier today, AMA, AHA, ANA issued an open letter urging the public to #StayHome to confront COVID-19.

March 22, 2020

CMS Delays 2019 MIPS Submission Deadline to April 30, 2020, Adds Hardship Exception for COVID-19; Provides Relief for 2019 Fourth Quarter ASC Quality Reporting
Today, CMS announced it would extend the deadline to submit 2019 MIPS data until April 30, 2020. In addition, CMS created a new extreme and uncontrollable circumstances hardship policy so that any physician or group who fails to report 2019 MIPS data by April 30, 2020 will receive a neutral payment adjustment in 2021. CMS is also evaluating options for providing relief for the 2020 MIPS performance year.
READ MORE

ASCRS Hosts Implementing Tele-Ophthalmology During COVID-19 Pandemic Webinar Next Week
On Thursday, March 26, at 3:00 p.m. ET, join ASCRS for the webinar, “Implementing Tele-Ophthalmology During COVID-19 Pandemic.” Recent government action has expanded telehealth coverage for Medicare beneficiaries nationwide, temporarily waiving penalties for HIPAA violations, and will reimburse physicians for telehealth services at the same rate for face-to-face services. ASCRS recognizes that our members need resources on how to implement telemedicine visits for their patients. Ranya Habash, MD, Medical Director of Technology Innovation and Assistant Professor of Clinical Ophthalmology at the Bascom Palmer Eye Institute, will provide an overview of tele-ophthalmology, sharing various use cases, practice workflows, and updates to Medicare guidelines and reimbursement during the COVID-19 outbreak. She will also share telehealth best practices used at Bascom Palmer Eye Institute during this critical time. Stephen D. Klyce, PhD, FARVO, Adjunct Professor of Ophthalmology at Icahn School of Medicine at Mount Sinai, chair of the ASCRS ASOA Telemedicine Task Force and ASCRS FDA Committee member will moderate the webinar. Following the presentation, audience members may participate in the Q&A session.

This webinar is free to all ASCRS and ASOA members. You can view the webinar archive here.

March 20, 2020

The following guidance from BSM Founder and CEO Bruce Maller is being shared with the permission of BSM Consulting. Additionally, BSM, an ASOA Platinum Strategic Business Partner, is hosting a webinar entitled “Business Survival Through the COVID-19 Crisis” on March 26th and has graciously extended the invitation to ASOA members to participate. Click here for additional information and to register.

BSM Founder and CEO Bruce Maller shares helpful advice for your business. 
What we are experiencing with COVID-19 is unprecedented. Clearly, we are in unchartered waters where the immediate and downstream implications are difficult to comprehend and measure. For practice leaders, your team will be looking for you to demonstrate your strong and effective leadership. Based on my experience managing through periods of distress and change, below are several suggestions on how to navigate this crisis. 

Remain calm. Now more than ever your team is counting on you to avoid being reactive. Remain positive and consider embracing one of my favorite comments from my late and great partner and friend Lisa Peltier: “We can do this.” 

Engage your key stakeholders in assessing the current situation and developing a plan of action. Identify the “right” members of your team who have the fabric, attitude, and smarts to help manage this planning process. 

Be decisive. This is not a time to be uncertain or vague. None of us has the answers or a playbook we can go to. Trust your instincts and your core team to guide your decision-making. 

Show compassion. One of the great gifts of outstanding leaders is their ability to be empathetic, especially during times of crisis. 

Communicate in clear and concise terms. Although we don’t — and likely won’t — have all the answers, messaging should be in small, bite-size pieces. Your team and patients are being bombarded with so much information right now. By being focused and clear in communicating your priorities, you will bring some comfort and support to your employees and patients. 

Be honest but hopeful. This is not a time to hide behind the truth. Be open and transparent in sharing relevant information but also reinforce a message of hope that includes a return to normalcy as the country works to contain the spread of this virus. 

Ask for flexibility and accommodation from your team. The world as we once knew it has changed. This change will create opportunity if team members are adaptable and flexible, which, as we know, is more challenging when the path forward is unclear and uncertain. 

Ask for flexibility and accommodation from your suppliers and service providers. Extended payment terms and modifications to loan agreements should be explored. 

Scrutinize every line item of expense on your income statement and take action to eliminate any non-essential spend. Be sure to check and review every invoice to make sure you are not releasing funds you may otherwise need for payroll and other essentials. 

Remember that during a time of crisis, you need to focus on preserving cash flow while also identifying sources of cash (e.g. bank lines of credit and loans or capital contributions from the business owners).

We acknowledge that the path forward for you will be impacted by many factors, including geographic area of the practice, availability of testing, the rate of new COVID-19 cases, as well as state and federal government intervention and guidance. Additionally, we recognize that the financial position of your practice and its owners will also impact various elements of your plan. Be as thoughtful as you can.