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Tag: FQHC/RHC

IMPORTANT COVID-19 FUNDING UPDATE | MAY 22, 2020

 

  • This Sunday, May 24, is the deadline for attesting to CARES provider relief payments received on April 10.
 

Toyon’s COVID-19 Funding Resources (updated for interactive national modeling of funding)
Toyon University’s COVID-19 Funding and Documentation Presentation

  • Wednesday, June 3, is the deadline to submit COVID-19 expenses for
    additional provider relief funding. Providers may be eligible for payments
    from the remaining
    funds through targeted distributions.
     
  • Toyon estimates $27.6
    billion in unallocated
    funding.
 

Toyon is pleased to provide this update on
developing details from the CARES Act Public Health and Social Services Emergency Fund (PHSSEF). For more information, or to contact any of our team members, please feel free to check Toyon’s website.
Important Deadlines: May 24 and June 3
This Sunday, May 24 is the deadline for providers receiving CARES PHSSEF payments on April 10 to attest the terms and conditions (T&C)

Providers that do not attest to the T&C and retain the funds past 45 days will retain payments and be included in HHS’s public release of providers and payments. In HHS’s updated FAQs, the agency states:

“Generally, HHS does not intend to recoup funds as long as a provider’s lost revenue and increased expenses exceed the amount of Provider Relief funding a provider has received.”

Providers must also submit revenue detail by June 3 to receive additional funding from the PHSSEF Distribution.
Please visit Toyon University’s COVID-19 Funding and Documentation Presentation for a discussion on submitting expenses and revenue loss. In HHS’s updated FAQs, HHS indicates this information may be used for other funds, such as the High Impact Fund. HHS states:

“Providers should update their capacity and COVID-19 census data to ensure that HHS can make timely payments in the event that the provider becomes a high-impact provider. Providers can continue to update their information through the same method they used previously.”

Also, providers are required to accept HHS’s T&C and submit revenue information to be considered for additional relief payments.

Toyon’s estimation of unallocated funds (to eligible hospitals) from the CARES Act PHSSEF is below. It is noted some of this funding will be used as part of provider relief funding for skilled nursing facilities (SNF) and HRSA’s Uninsured Program.

$50,000 Payments to RHCs for COVID-19 testing | expenses
Also included in HHS’s provider relief funding update is a distribution of $225 million to RHCs for COVID-19 testing. Payments are based on the number of certified clinic sites. HHS also released RHC T&Cs here. 

Provider relief for Skilled Nursing Facilities
As part of the CARES provider relief funding, HHS is distributing $50,000 to each SNF plus a variable distribution between $2000 per bed for smaller SNFs (5 and 25
beds) and $1,8000 per bed for larger SNFs (more than 200 beds). HHS also released SNF T&Cs here.


Thank you

Toyon is committed to apprising providers with important reimbursement updates and will keep you updated with the latest on UC DSH and COVID-19 funding and documentation.  Please feel free to visit Toyon’s COVID-19 Resources for updates on hospital funding estimates, recommendations on documenting cost and revenue losses associated with this public health emergency. Toyon’s website provides information on how to contact Toyon’s team members.   

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Required Billing Updates for RHCs

From: CMS MLN Articles – MM9269 – 3/23/16

What you Need to Know

Effective April 1, 2016, RHCs, including RHCs exempt from electronic reporting under Section 424.32(d)(3), are required to report the appropriate HCPCS code for each service line along with the revenue code, and other required billing codes. Payment for RHC services will continue to be made under the All-Inclusive Rate (AIR) system when all of the program requirements are met. There is no change to the AIR system and payment methodology, including the “carve out” methodology for coinsurance calculation, due to this reporting requirement.

Read more: Required Billing Updates for RHC

 

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Required Billing Updates for RHCs – Eff. April 1, 2016

From: CMS Transmittal 1596; 1/26/16

Transmittal Excerpt:

New Policy:

Effective for dates of service on or after April 1, 2016, RHCs, including RHCs exempt from electronic reporting under §424.32(d)(3), are required to report the appropriate HCPCS code for each service line along with the revenue code, and other codes as required.

Payment for RHC services will continue to be made under the all-inclusive rate (AIR) when all of the program requirements are met. There is no change in the AIR system and payment methodology including the “carve out” methodology for coinsurance calculation due to this reporting requirement.

Read more…

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