CARES Provider Relief Payment

Published in Women's Health on April 22, 2020

Many EW members who have billed Medicare in 2019 have received a check for the relief payment, but within that check states that they are required to sign an attestation form and agree to terms and conditions. Many are confused about particular items in these terms and conditions, including the statement that they must be involved in providing care for COVID-19 patients and use the funds to provide care or respond to COVID-19.

Craig Douglas, VP of Payer and Member Relations for VGM & Associates, provides his insight on the matter here:

"Below are the points I have sent others that explain why you qualify to receive them and are well within your rights to keep the money if you so choose. Really, your decision to keep the money should be more about your willingness to agree to the terms and conditions than about your qualification to receive and keep the money.

1. Yes, I still believe you qualify to receive and keep this money, because I believe all of these statements are true for you and your business meets the following requirements for eligibility:

Eligibility to receive funds: All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.
This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services.
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.

2. I haven’t seen anything stating you have to provide care regardless of an individual’s ability to pay. You are simply required to accept the fee schedule, which would include any applicable deductible and co-insurance, as payment in full, and not charge the patient above and beyond the published allowable.

The Secretary has concluded that the COVID-19 public health emergency has caused many healthcare providers to have capacity constraints. As a result, patients that would ordinarily be able to choose to receive all care from in-network healthcare providers may no longer be able to receive such care in-network. 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.

3. At the end of the day, if you are not comfortable with keeping the funds for whatever reason, you can return the funds for peace of mind. If you decide not to keep the funds, you can call United Healthcare to begin the process of refunding the payment if you decide you don’t want to keep it."

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