CARES PROVIDER RELIEF FUND (PRF) Phase 4 Funding Update
1. Begins Distributing Phase 4 Payments
2. Toyon’s Template is Available to Assist Providers Reconcile Phase 4 Base Payments.
3. Providers have until December 20, 2021 (11:59 PM ET) to correct errors related to PRF Reporting Period 1.
Toyon is pleased to provide this update on the CARES Provider Relief Fund (PRF). For more information, please contact Fred Fisher at 888.514.9312, email@example.com.
1. HRSA is Distributing Phase 4 Funds
Today, December 16, 2021, HRSA began distributing $9 billion, out of $17 billion, in Phase 4 Funding to more than 69,000 providers.
Phase 4 Base Payments
75% of Total Phase 4 Funding ($12.75 billion)
Phase 4 Funding is broken down into two parts, with the first being the Base Phase 4 payment. Phase 4 base payments are adjusted depending on annual patient care revenue. Funding percentages range from 20% (for large providers) to 45% (for small providers). These funding percentages are significantly less than the 88% funding percentage applied in Phase 3.
- Small sized providers receive 45% of Phase 4 losses. Small providers have less than or equal to $10 million in annual patient care revenue. The current average payment is $58,000.
- Medium sized providers receive 25% of Phase 4 losses. Medium providers have more than $10 million and less than $100 million in annual patient care revenue. The current average payment is $289,000.
- Large sized providers receive 20% of Phase 4 losses. Large providers have $100 million or more in patient care revenue. The current average payment is $1.7 million.
HRSA’s Phase 4 methodology takes additional steps to flag aberrant data, and offset losses for “PRF payments not previously deducted in Phase 3.” Toyon believes HRSA is carrying forward PRF in excess of Phase 3 losses and reducing Phase 4 payments by this amount.
25% of Total Phase 4 Funding (~$4.25 billion)
In addition to the Base Phase 4 payment, HRSA is also disbursing “bonus” Phase 4 payments. Similar to rural payments from the American Rescue Plan (ARP), Phase 4 bonus payments are based on Medicare, Medicaid, and CHIP administrative claims data from January 1, 2019 through September 30, 2020 (Phase 4 bonus payments uses all claims as compared to the Rural ARP which uses rural claims).
HRSA calculates Phase 4 bonus payments by determining the difference between payments at Medicaid rates versus payments at Medicare rates. The difference in payments is then reduced in a budget neutral manner to fit “the portion of funding set aside for bonus payments.” Based on eligibility criteria to apply for Phase 4 payments, it is believed HRSA used inpatient and outpatient claims from both Fee for Service and Managed Care payors.
2. Toyon’s Template to Reconcile Phase 4 Base Payments
Please feel free to use Toyon’s template to reconcile Base Phase 4 payments. The template is available here for download on Toyon’s website.
- The first of the two tabs is populated with hypothetical information to show how the provider’s Phase 4 payment was determined.
- The second tab is a template for provider input.
- To use this tab, input information into the grey cells and the formulas will calculate throughout the spreadsheet.
- Please note the current template utilizes thresholds to determine aberrant data, and potential “flags”, from thresholds established in Phase 3.
- To avoid amounts from being adjusted from any flags, please ensure “Yes” is populated in key columns AD and AJ.
3. CARES PRF Reporting Period 1 Correction and Period 2 Reporting
The PRF Period 1 Reporting Portal is now open through December 20, 2021 (11:59 PM ET) for any provider that still needs to register or submit | correct information related to PRF Reporting Period 1. PRF recipients looking to correct an error must contact the Provider Support Line (866-569-3522) to gain access to their submitted report.
The PRF Period 2 Reporting Portal is slated to open on January 1, 2022 and close March 31, 2022. PRF Reporting Period 2 will cover PRF amounts received from July 1, 2020 through December 31, 2020 and expenses and lost revenues incurred during the “period of availability” of January 1, 2020 through December 31, 2020 (excluding any amounts that were already applied towards PRF Reporting for Period 1).
Toyon is committed to apprising providers with important reimbursement updates and will keep you updated with the latest COVID-19 funding and documentation news. Please feel free to visit Toyon’s COVID-19 Resources for more information.