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APRIL 23, 2020 -- The federal government will start distributing more than $40 billion from the COVID-19-related $100 billion Provider Relief Fund beginning as soon as April 24, and it will also soon initiate a process for hospitals and clinicians to be reimbursed for testing and treating uninsured patients, officials said on Wednesday.
The federal government distributed $30 billion of the $100 billion to Medicare facilities and clinicians on April 10 and 17.
The Provider Relief Fund is carved out of the $2.2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act, which President Donald J. Trump signed into law on March 27. The $1 billion Families First Coronavirus Response Act (FFCRA), signed into law on March 18, specifically provides reimbursement for testing uninsured patients.
"Our goal in all of the decisions we're making is to get the money from the Provider Relief Fund out the door as quickly as possible while targeting it to those suffering the most from the pandemic," said US Department of Health and Human Services (HHS) Secretary Alex Azar in a statement.
The new round of payments will be split into a handful of buckets: $20 billion for Medicare facilities and clinicians; $10 billion to hospitals in COVID-19 hot spots; $10 billion for rural health clinics and hospitals; and $400 million for the Indian Health Service (IHS).
That means about $27 billion of the $100 billion has not as yet been allocated. On a call with reporters, Azar said that HHS is working on creating payment programs for dentists, providers who only take Medicaid, and skilled nursing facilities.
How to Get Paid
Facilities and clinicians eligible for the $20 billion general fund — open only to those who participate in Medicare — will receive an amount proportional to their share of 2018 net patient revenue.
Some providers — those who have already submitted cost report data to the Centers for Medicare & Medicaid Services — will receive an automatic payment as soon as April 24. All others will have to submit revenue information to a portal opening soon at hhs.gov/providerrelief.
Anyone who receives those funds has to confirm receipt and agree to the terms and conditions.
One important condition: Providers cannot bill any patient at an out-of-network rate. This is in keeping with the administration's promise that there will be no surprise medical bills for patients who are presumed to have COVID-19 or are treated for the illness.
Physicians and other healthcare clinicians also have to agree to not engage in balance or surprise billing if they seek reimbursement for testing or treatment of uninsured patients.
The Health Resources and Services Administration (HRSA) has set up a new website that will begin accepting applications April 27 for hospitals, physicians, and others seeking payment for a test or treatment for uninsured patients presumed to have COVID-19 or who tested positive for the disease.
Reimbursement — which will be at the Medicare rate — for treatment of uninsured patients is coming from the $100 billion Provider Relief Fund, but Azar would not say how much will be allocated for this purpose.
Doctors and hospitals can seek payment for services dating back to February 4. They must enroll, check patient eligibility and benefits, submit patient information, and submit a claim. They cannot begin submitting claims until early May, and payment will likely start later in May. Once everything is verified, they will be paid via direct deposit.
HRSA Administrator Thomas J. Engels told reporters that, regarding testing, the program will cover specimen collection, diagnostic and antibody testing, and testing-related visits at physician offices, urgent care facilities, emergency departments, or by telehealth. Regarding treatment, the funds will cover office or emergency department visits, inpatient or outpatient visits, observation, telehealth, skilled nursing care, acute rehabilitation, and treatment at long-term care facilities.
Durable medical equipment, such as oxygen and ventilators, and urgent and nonurgent transport will also be covered for uninsured patients.
However, the program only covers US Food and Drug Administration (FDA)–approved drugs and only when given during an inpatient stay, said Engels. The FDA has not approved any treatment for COVID-19.
The program will cover a vaccine when and if it becomes available, he said.
Hospitals Must Apply Fast
The new money for hospitals is being distributed in a way that ensures that all facilities — not just those that treat Medicare patients — will benefit, said Azar.
He said that one children's hospital had only received $233,000 in the first round but would be getting $32 million in this round.
Hospitals in the hardest hit areas, such as New York, will be getting the largest portion of the hot-spot money. Senate Minority Leader Chuck Schumer (NY) said in a news release that his state's doctors and hospitals would be receiving $4.3 billion of the $10 billion allocated in this round for hardest-hit areas. Azar confirmed that amount with reporters.
Hospitals in other hot zones have until midnight Pacific Standard Time on April 23 to apply for hot-spot funds. The eventual allocation will be based on the total number of intensive care unit beds as of April 10 and on the total number of patients who tested positive for COVID-19 and were admitted from January 1 to April 10.
The data collected through this process will be used to determine which areas will get funds.
Rural hospitals seeking a portion of their targeted $10 billion will be given money on the basis of operating expenses.
Azar also addressed an ongoing outbreak in the Navajo Nation and the stress the outbreak was placing on the Indian Health Service. IHS facilities will receive money beginning the week of April 27. Their portion of the $400 million will be determined by operating expenses.