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Follow up: Federal Payments to Physicians Who Bill Medicare Fee for Service

  • 1.  Follow up: Federal Payments to Physicians Who Bill Medicare Fee for Service

    Posted 04-10-2020 03:58 PM
    Things are moving quickly and here is a follow up on the federal CARES Act:
     
    Today Health and Human Services released information that they will be processing an initial payment pool of $30 billion from the healthcare portion of the CARES Act. 
     
    Payments will go to physician practices who bill Medicare Fee for Service. It is anticipated that subsequent payments will be released for other criteria besides Medicare Fee for Service.
     
    Below are some key components about what providers will receive a portion of this payment and how to estimate the amount of the payment.
    For HHS source document: https://www.hhs.gov/provider-relief/index.html

    How this applies to different types of providers

    All relief payments are being made to providers and according to their tax identification number (TIN). For example:
    • Large Organizations and Health Systems: Large Organizations will receive relief payments for each of their billing TINs that bill Medicare. Each organization should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
    • Employed Physicians: Employed physicians should not expect to receive an individual payment directly. The employer organization will receive the relief payment as the billing organization.
    • Physicians in a Group Practice: Individual physicians and providers in a group practice are unlikely to receive individual payments directly, as the group practice will receive the relief fund payment as the billing organization. Providers should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
    • Solo Practitioners: Solo practitioners who bill Medicare will receive a payment under the TIN used to bill Medicare.

    How are payment distributions determined

    • Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.
    • A provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000, and multiply that ratio by $30,000,000,000. Providers can obtain their 2019 Medicare FFS billings from their organization's revenue management system.
    • As an example: A community hospital billed Medicare FFS $121 million in 2019. To determine how much they would receive, use this equation:
      • $121,000,000/$484,000,000,000 x $30,000,000,000 = $7,500,000


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    Malcolm Porter
    CMA Public Policy/Political Consultant
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