Healthcare Practice Relief Options in CARES Act

According to the Healthcare Business Management Association (HBMA) there are a couple of provisions in the law that will be of interest to healthcare providers.

1. Healthcare Provider “lost revenue/ increased cost” Grants

The CARES Act establishes a $100 Billion Grant Fund exclusively for healthcare providers who are enrolled in the Medicare and Medicaid program. The purpose of this fund is to provide grants to practices that have experienced a reduction in revenue or an unexpected increase in costs due to the COVID-19 pandemic. The money will be available during the period of the national emergency.

Many healthcare providers have reported that they have seen a significant drop in revenue because of a drop in patient volume. Patients are concerned about coming into the office – even for routine visits. Similarly, many “elective” non-essential surgeries have been canceled leaving surgeons and anesthesiologists without income. These are not just Medicare patients, but Medicaid and commercially insured patients as well. Consequently, cash flow for many healthcare providers is a serious problem.

The Healthcare Provider Lost Revenue Grant program is intended to provide medical practices with an infusion of money that will help replace the money lost due to reduced patient volume because of the COVID-19 pandemic.

The Department of Health and Human Services (HHS) is currently working on a formula to determine how to calculate a provider’s lost revenue. This is lost revenue whether it is reduced volume for Medicare, Medicaid, or commercially insured patients.

It may take a week to 10 days for CMS to have all of the necessary applications in place to get the money flowing but these grants could be critically important for healthcare providers that are experiencing a revenue decline due to COVID-19.

More on this as it becomes available.

2. Medicare Advanced Payments

The Coronavirus Aid, Relief, and Economic Security (CARES) Act authorizes CMS to expand the current Accelerated and Advance Payment Program to a broader group of Medicare healthcare providers and suppliers. The expansion of this program is only for the duration of the public health emergency.

An accelerated/advance payment is a payment intended to provide necessary funds when there is a disruption in claims submission and/or claims processing.

CMS is authorized to provide accelerated or advance payments during the period of the public health emergency to any Medicare provider/supplier who meets the required qualifications(see below) and who submits a request to the appropriate Medicare Administrative Contractor (MAC).

To qualify for advance/accelerated payments the provider/supplier must:

  1. Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider/supplier request form,
  2. Not be in bankruptcy,
  3. Not be under active medical review or program integrity investigation, and
  4. Not have any outstanding delinquent Medicare overpayments.

Healthcare providers seeking an advanced Medicare payment can request a specific amount using a form available on each Medicare Administrative Contractor’s website. Most healthcare providers will be able to request up to 100% of the Medicare payment amount for a three-month period. The provider can continue to submit claims as usual after the issuance of the accelerated or advance payment

Repayment of the advanced payments will commence 120 days after the date of issuance of the payment and providers will have 210 days from the date of the accelerated or advance payment was made to repay the balance.

At the end of the 120-day period, the recoupment process will begin and every claim submitted by the provider will automatically be offset from the new claims to repay the advanced payment. Thus, instead of receiving payment for newly submitted claims, your outstanding advance payment balance is reduced by the claim payment amount.

For a more detailed explanation of this initiative, you can review the CMS  Advanced Payment Fact Sheet.

For more information and to get a copy of the form to request an advanced payment, go to your Medicare Administrative Contractor’s website or call your MACs Corona Virus Hotline:

For more information or for any questions, please contact Brenda Wallace at

*Used with permission from Healthcare Business Management Association

Copyright © 2020 The Healthcare Business Management Association (HBMA), All rights reserved.

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