Medicare Compliance & Reimbursement

Document where your reimbursement is coming from — and how you’re using it.

Now that the feds have replenished the Small Business Administration’s Paycheck Protection Program (PPP), providers have another COVID-19-funding option to choose from. But the relief funds are sure to go quickly, so you may want to review the two available financial assistance programs ASAP.

Reminder: You won’t have to pay back money from the PPP program or the Provider Relief Fund, as long as you meet certain terms and conditions. In contrast, you’ll need to repay accelerated payments within 210 days, with recoupments starting after day 120.

Another difference: Even within the two programs where the payments can be forgiven, there are important differences, points out Dave Macke with VonLehman & Co. in Fort Wright, Kentucky. For example, with PPP loans, companies have to spend the amount within eight weeks, and can spend it only on payroll, rent, utilities, and/or mortgage interest. In contrast, there’s no deadline for CARES Act Provider Relief Fund spending, and it can go for any COVID-19-related expenses or losses, he says.

While the Provider Relief Fund is a bit less structured, it comes with a bevy of documentation requirements, including these two that are worrying providers:

The Recipient certifies that the Payment will only be used to prevent, prepare for, and respond to coronavirus, and that the Payment shall reimburse the Recipient only for healthcare-related expenses or lost revenues that are attributable to coronavirus.

The Recipient certifies that it will not use the Payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.

And the requirements aren’t casual. “All recipients will be required to submit documents sufficient to ensure that these funds were used for healthcare-related expenses or lost revenue attributable to coronavirus,” the Department of Health & Human Services (HHS) stresses on its Provider Relief Fund webpage. There will be significant anti-fraud and auditing work done by HHS, including the work of the Office of the Inspector General, says HHS’ Provider Relief Fund webpage.

“The best practical advice at the moment for any provider intending to use Relief Fund payments, or any other relief program mechanism, is to document in detail how COVID-19-related expenses are being reimbursed, document prior and ongoing drops in patient volume, and exercise commonsense judgment in determining whether a provider’s use of funds is appropriate,” advise attorneys Mark Cunningham, Doug Griswold, and Jed Roebuck with Chambliss, Bahner & Stophel, P.C. in Chattanooga, Tennessee Good news: It shouldn’t be too tough to prove your services were coronavirus-related. “HHS broadly views every patient as a possible case of COVID-19,” it says on its Provider Relief Fund page under the “Who is eligible for initial $30 billion” drop-down section.

But providing that you have not used “the Payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse” may require more work, experts fear. “Expenses and losses cannot be charged twice,” points out consulting firm The Health Group in Morgantown, West Virginia.

Try this: “Because providers have 30 days after the receipt of funds to return the money, it is recommended to hold the Relief Funds, if possible, and not provide any certifications until further guidance is issued from HHS,” Cunningham, Griswold, and Roebuck counsel.

Depositing any Provider Relief Fund payments into a separate bank account will help you keep track of the funds, The Health Group advises. “When received, the healthcare provider should establish a liability account entitled ‘Unearned Provider Relief Funds,’” the firm recommends. “This liability account will be relieved as COVID-19 related expenses are incurred or as COVID-19 related lost revenues are computed and reported. Likewise, revenue will be recognized as qualifying expenses and lost revenues are recognized.”

Thoughts: “We are navigating unprecedented circumstances. Within the context of the Provider Relief fund, the federal government has taken the remarkable step of doling out large sums of money with little forewarning,” stress Cunningham, Griswold, and Roebuck. “Eligibility instructions for Relief Fund payments have been nebulous, and the information as to how payments can actually be used is sparse and generally unclear.”

Don’t forget: Even though HHS is emphasizing that providers don’t have to repay Provider Relief Funds, “such funds can only be used for COVID-19 related expenses or COVID-19 related lost revenues,” The Health Group stresses in its electronic newsletter.

Plus: To keep their funds, providers must sign their attestations within 30 days and submit any required paperwork via the CARES Act Provider Relief Fund General Distribution Portal at https://covid19.linkhealth.com.