HHS Issues New Provider Relief FAQ and says More Relief Coming

Regulation | May 11, 2020 | by Nicole Fallon

The U.S. Department of Health and Human Services (HHS) issued an updated Frequently Asked Questions (FAQ) document late Friday, May 8 which includes two new pages of information and clarifications regarding the Provider Relief Fund and in a meeting with HHS Deputy Secretary Eric Hargan told LeadingAge CEO Katie Smith Sloan that additional relief is coming.

Hargan indicated that the next round of relief payments will be going to Indian Health Services facilities and SNFs in COVID-19 hotspots, which is an item LeadingAge requested in a recent letter to HHS Secretary Alex Azar. When asked about relief payments for Medicaid providers, he added, “we are working on it. The delay is not a policy delay but a technical issue.” He went on to explain the process of obtaining provider lists from states then matching them against Medicare files to ensure that the providers are Medicaid-only (no Medicare billing) for this next round of payments.

In the FAQ, HHS clarifies:

  • HHS broadly views every patient as a possible case of COVID-19.
  • Funds can be recouped in the future if a provider’s health care related expenses and lost revenues attributable to the coronavirus to not equal or exceed the payment(s) received and those expenses and lost revenues were not reimbursed or required to be reimbursed from other sources.
    • Hargan also noted that HHS may look at cases where the provider had very small losses (he suggested less than 2% but said it’s not a hard and fast standard), the government might recoup the funds.

  • Funds can also be recouped for failure to comply with the terms and conditions.
  • While there is a prohibition on balance billing for presumptive or actual COVID-19 patients as part of the terms and conditions, this FAQ clarifies that out-of-network providers simply cannot charge cost sharing in excess of what the patient would have paid through an in-network provider. This prohibition applies to presumptive and actual COVID-19 cases not to possible COVID-19 cases.
    • Presumptive cases are those where the patient’s medical record documentation supports a COVID-19 diagnosis even if the patient does not have a positive COVID-19 test result in the record.
  • Not much new news on reporting requirements except to reiterate they will begin for the calendar quarter ending June 30, 2020. The new FAQs also indicate there is more to guidance forthcoming "about the type of documentation we expect recipients to submit.”


Returning Payments

Finally, for providers who received funds erroneously or received more than was expected, the FAQs walks through how providers can return these funds. These providers should still go to the Attestation Portal and reject the entire General Distribution payment. The portal will guide providers through the process for returning the funds. These steps include:

  • The provider contacting their financial institution
  • Asking the financial institution to refuse the ACH credit by initiating an ACH return using the ACH return code of “R23 – Credit Entry Refused by Receiver.”

For providers who received a paper check, after rejecting the funds through the Attestation Portal, the provider should destroy the check if not yet deposited or mail a paper check for the amount received to United Health Group indicating they are returning the funds.

After returning the funds, providers who returned a payment that was much more than expected should submit the appropriate revenue documents through the General Distribution portal in order to receive the correct payment from HHS. These payments are anticipated to be processed within 10 business days.

LeadingAge will update its Provider Relief Fund Background, Considerations and FAQ document to reflect the latest HHS FAQ guidance.