Accelerated Payments Eligibility
Various sections within the 42 Code of Federal Regulations provide for an accelerated payment to providers that experience a temporary delay in claims payments (delays may be caused by the claims payment delays by the intermediary, or in exceptional situations, by provider delays in submitting or processing claims.
Specifically, Section 413.64(g) of the 42 Code of Federal Regulations provides the general guidelines for an accelerated payment. For providers receiving payments under a Prospective Payment System, see the specific Code of Federal Regulations section to determine whether the provider may qualify for an accelerated payment. For example, Section 413.632(e) provides the rules for providers receiving payment under the Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units. An accelerated payment must be recovered within 90 days of its issuance date. If the provider cannot pay 100 percent of the accelerated payment, the remaining amount due at the end of the 90-day period will be deemed an overpayment.
A provider may request an accelerated payment where delays in payments by an intermediary for covered services rendered to beneficiaries have caused financial difficulties for the provider. An accelerated payment may also be made in highly exceptional situations where a provider has incurred a temporary delay in its billing process beyond the provider's normal billing cycle. A request for an accelerated payment may not be approved unless the provider meets all eligibility requirements, including an assurance recovery of the accelerated payment by the intermediary may be made on a timely basis. The amount of the accelerated payment is computed as a percentage (sufficient to alleviate the impaired cash position but in no case to exceed 70 percent) of the amount of net reimbursement represented by unbilled discharges or unpaid bills applicable to covered services rendered to beneficiaries.
Eligibility Requirements
A provider's eligibility for an accelerated payment is contingent upon all of the following conditions:
- A shortage of cash exists, whereby the provider cannot meet current financial obligations.
- The impaired cash position is due to abnormal delays in claims processing and/or payment by the intermediary. However, requests for accelerated payments based on isolated temporary provider billing delays may also be approved where the delay is for a period of time beyond the provider's normal billing cycle. In this instance, the provider must assure and demonstrate the causes of its billing delays are being corrected and not chronic.
- The provider's impaired cash position would not be alleviated by receipts anticipated within 30 days, which would enable the provider to meet current financial obligations.
- The basis for financial difficulty is due to a lag in Medicare billing and/or payments and not due to other third-party payers or private patients.
- The FI is assured a timely recovery of the payment is likely.
NOTE: Providers receiving payments under the Periodic Interim Payment (PIP) method are not eligible for an accelerated payment. Neither the revision of the current financing regulations nor the recovery of current financing payments is a basis for justifying a provider's request for an accelerated payment.
The following forms must be completed and submitted with the supporting documentation
If you have any questions, please contact your assigned Home Office Audit Supervisor assigned
The Home Office Contact Listing is available at: http://www.wpsmedicare.com/part_a/
business/home_office.shtml
Page Last Updated: Thursday, 18-Mar-2010 05:48:33 CDT
