Medicare Compliance & Reimbursement

If you are eligible for Phase 4 HHS Provider Relief Fund (PRF) payments and plan on applying for additional money, know that the deadline is fast approaching.

Reminder: Last month, the Department of Health and Human Services (HHS) announced another $25.5 billion of relief funding — $17 billion for Phase 4 and $8.5 billion in American Rescue Plan (ARP) resources — to help “providers who have endured demanding workloads and significant financial strains amidst the pandemic,” says HHS Secretary Xavier Becerra in a release. “The funding will be distributed with an eye towards equity, to ensure providers who serve our most vulnerable communities will receive the support they need.”

PRF payments: Under the Phase 4 distribution, a plethora of providers are eligible to apply for PRF money, including those who bill Medicare Parts A/B fee-for-service claims and Medicare Advantage. Consistent with the CARES Act of 2020, HHS will base PRF Phase 4 payments on providers’ lost revenues and expenditures between July 1, 2020, and March 31, 2021, HHS specifies in the release.

HHS will calculate 75 percent of the Phase 4 allocation “based on revenue losses and COVID-related expenses,” the Health Resources & Service Administration (HRSA) explains. And it will put 25 percent “towards bonus payments that are based on the amount and type of services provided to Medicaid, CHIP, and Medicare patients,” the agency says.

ARP rural funds: HRSA will make ARP rural payments to providers “based on [the] amount and type of Medicare, Medicaid, and CHIP services provided to rural patients from Jan. 1, 2019 through Sept. 30, 2020,” a fact sheet on the distribution notes.

Providers can apply for both ARP rural funds and Phase 4 PRF payments on the same application, and HHS will use existing claims data to determine amounts, HRSA guidance suggests. The application opened on Sept. 29 and will close on Oct. 26 at 11:59 p.m. EST, but HRSA advises interested applicants to not delay.

Why? “Applications must undergo a number of validation checks before financial information is submitted so providers are encouraged to begin their application as soon as possible to ensure they are able to meet the deadline,” HRSA warns.

You can find myriad application materials, including eligibility requirements, sample forms, FAQs, tax data, and payment methodologies, at www.hrsa.gov/provider-relief/future-payments.