There are three reasons that a provider may request an accelerated payment. The first is when there is a delay in payment by Noridian for covered services rendered to beneficiaries and this delay has caused financial difficulties for the provider. The second is in highly exceptional situations where a provider has incurred a temporary delay in its billing process beyond the provider's normal billing cycle. The last reason is in highly exceptional situations where CMS deems an accelerated payment is appropriate.
The amount of the accelerated payment is computed as a percentage sufficient to alleviate the impaired cash position, but in no case to exceed seventy percent of the amount of net reimbursement represented by unbilled discharges or unpaid bills applicable to covered services rendered to beneficiaries. This is computed by taking the interim reimbursement less deductibles and coinsurance and multiplied by seventy percent. All accelerated payments will need to be approved by the appropriate CMS Regional Office. No accelerated payment requests will be approved without meeting the eligibility requirements.
The following are the eligibility requirements required to be met to be approved for an accelerate payment:
- A shortage of cash exists whereby the provider cannot meet current financial obligations; and
- The impaired cash position described is due to abnormal delays in claims processing and/or payment by the Medicare Administrative Contractor (MAC) (Noridian). However, request for accelerated payments based on isolated temporary provider billing delays may also be approved where the delay is for a period of time beyond the provider's normal billing cycle. In this instance, the provider must assure and demonstrate that the causes of its billing delays are being corrected and are not chronic; and
- The provider's impaired cash position would not be alleviated by receipts anticipated within 30 days which would enable the provider to meet current financial obligations; and
- The basis for financial difficulty is due to a lag in Medicare billing and/or payments and not to other third-party payers or private patients; and
- The MAC is assured that recovery of the payment can be accomplished according to the instructions in the CMS Internet Only Manual (IOM), Medicare Financial Management Manual, Publication 100-06, Chapter 3, Section 150.4.
Noridian will attempt to recover any accelerated payment within ninety days after it is issued. To the extent that a delay in the provider's billing process is the basis for the accelerated payment, recoupment is made by a one hundred percent withhold against the provider's bills processed by Noridian or other monies due the provider after the date of issuance of the accelerated payment. Any remainder is recovered by direct payment by the provider not later than ninety days after issuance of the accelerated payment.
If the payment is necessitated by abnormal delays in claims processing and/or payment by Noridian, recovery by recoupment will be reasonably scheduled to coincide with improvement in Noridian's bill processing situation and such recoupment will not impair the provider's cash position. In this situation, recoupment shall be completed within ninety days of Noridian processing the provider's claims.
If recovery is not complete ninety days after the accelerated payment is issued or ninety days after Noridian begins processing claims, the accelerated payment is considered delinquent and Noridian will immediately put the provider on one-hundred percent withhold until the debt is paid in full.
Last Updated Nov 08, 2016