The American Society of Dermatopathology

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CARES Act Provider Relief Fund Grid

Find information about payment qualifications and requirements, payment allocations and actions needed from recipients of provider relief payments. Due to the complexity of relief payments, this grid has been assembled so you can cross-reference information from HHS, AMA, AAD and CAP.

 
Health and Human Services

Payment Qualifications and Requirements

Why are payments being distributed?

This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services. If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

Who will receive payments?

All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.

Definition of ‘Payment’

These are payments, not loans, to healthcare providers, and will not need to be repaid.

Where will payments be sent?

All relief payments are made to the billing organization according to its Taxpayer Identification Number (TIN). Payments to practices that are part of larger medical groups will be sent to the group's central billing office.

Attestation Requirements

Not addressed.

Where will this payment come from?

HHS has partnered with UnitedHealth Group (UHG) to provide rapid payment to providers eligible for the distribution of the initial $30 billion in funds. Providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS). The automatic payments will come to providers via Optum Bank with "HHSPAYMENT" as the payment description. Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well, within the next few weeks.

Conditions for receiving funds

As a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider. Visit the HHS website for a PDF copy of the Terms and Conditions.

Payment Allocation

How are payments allocated?

Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.

How much will I receive?

A provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000, and multiply that ratio by $30,000,000,000. Providers can obtain their 2019 Medicare FFS billings from their organization's revenue management system. As an example: A community hospital billed Medicare FFS $121 million in 2019. To determine how much they would receive, use this equation:

    • $121,000,000/$484,000,000,000 x $30,000,000,000 = $7,500,000

Actions Needed from the Recipient

Within 30 days of receipt of payment, you need to:

Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020, and will be linked on this page.

Terms and Conditions

HHS' payment of this initial tranche of funds is conditioned on the healthcare provider's acceptance of the Terms and Conditions - PDF, which acceptance must occur within 30 days of receipt of payment. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions. If a provider receives payment and does not wish to comply with these Terms and Conditions, the provider must do the following: contact HHS within 30 days of receipt of payment and then remit the full payment to HHS as instructed. Appropriate contact information will be provided soon.

Is this different than the CMS Accelerated and Advance Payment Program?

Yes. The CMS Accelerated and Advance Payment Program has delivered billions of dollars to healthcare providers to help ensure providers and suppliers have the resources needed to combat the pandemic. The CMS accelerated and advance payments are a loan that providers must pay back. Read more information from CMS.

American Medical Association

Payment Qualifications and Requirements

Why are payments being distributed?

Provides relief to both providers in areas heavily impacted by the COVID-19 pandemic and providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services.

Who will receive payments?

All facilities and health professionals that billed Medicare FFS in 2019 are eligible for the funds

Definition of ‘Payment’

These are grants, not loans, and do not have to be repaid.

Where will payments be sent?

Funds will go to each organization's TIN which normally receives Medicare payments, not to each individual physician.

Attestation Requirements

The HHS is disbursing these funds in advance of an attestation with the expectation that each recipient could document, if asked, that they have experienced lost revenue or increased costs that are at least equal to the amount of the grant.

Where will this payment come from?

The automatic payments will come to the organizations via Optum Bank with "HHSPAYMENT" as the payment description.

Conditions for receiving funds

The Recipient certifies that it billed Medicare in 2019; provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19; is not currently terminated from participation in Medicare; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently have Medicare billing privileges revoked.

Payment Allocation

How are payments allocated?

This initial $30 billion is being directed to hospitals and physician practices in direct proportion to their share of Medicare fee-for-service spending. The total amount of Medicare FFS spending in 2019 was $484 billion.

How much will I receive?

Hypothetically, if a Medicare provider with a Taxpayer ID Number (TIN) accounted for 1% of total Medicare FFS spending in 2019, the TIN would receive 1% of the $30 billion.

Actions Needed from the Recipient

Within 30 days of receipt of payment, you need to:

Not addressed.

  1. Terms and Conditions

Not addressed

 

Is this different than the CMS Accelerated and Advance Payment Program?

Not addressed.

American Academy of Dermatology

Payment Qualifications and Requirements

Why are payments being distributed?

Not addressed.

Who will receive payments?

Any practice that accepts Medicare fee-for-service payment (not Medicare Advantage) will receive a payment. Dermatologist owners of practices who received payments from Medicare fee-for-service (not Medicare Advantage) in 2019 will begin receiving direct deposit payments starting April 10, 2020.

Definition of ‘Payment’

These are payments, not loans, and will not need to be repaid.

Where will payments be sent?

These funds will be directly deposited in the accounts normally associated with Medicare payments. Each Tax Identification Number (TIN) linked to Medicare will receive a payment.  If you are an employed dermatologist, you should not expect to receive an individual payment directly. Your employer organization will receive the payment to their central billing office and determine how to disperse the funds. Solo dermatologists and dermatologist-owners of group practices should expect to see the funds in each TIN linked to Medicare.

Attestation Requirements

Not addressed.

Where will this payment come from?

The Department of Health and Human Services (HHS) has partnered with UnitedHealth Group to disperse the payments. The practice will be paid via Automated Clearing House account information on file with UnitedHealth Group or CMS. The automatic payment will come via Optum Bank with “HHSPAYMENT” as the payment description. If you receive paper checks from CMS, you will receive a paper check in the mail within the next few weeks.

Conditions for receiving funds

As a condition to receiving these funds, practices must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider and abstain from “balance billing” any patient for COVID-related treatment.

Payment Allocation

How are payments allocated?

The practice will receive funds equivalent to their 2019 Medicare fee-for-service payments (not Medicare Advantage) divided by 484 billion and multiply that ratio by 30 billion.

How much will I receive?

If your 2019 Medicare fee-for-service payment was $200,000 you would receive a one-time payment of $12,396, which is calculated by first dividing the payment by 484 billion and then multiplying the result by 30 billion.

Actions Needed from the Recipient

Within 30 days of receipt of payment, you need to:

Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The attestation will be done via web portal and be open the week of April 13, 2020.

Terms and Conditions

HHS’s payment of this initial tranche of funds is conditioned on acceptance of the Terms and Conditions (PDF download), which acceptance must occur within 30 days of receipt of payment. If a provider receives payment and does not wish to comply with these Terms and Conditions, the provider must do the following: contact HHS within 30 days of receipt of payment and then remit the full payment to HHS as instructed. Appropriate contact information will be provided soon.

Is this different than the CMS Accelerated and Advance Payment Program?

Not addressed.

College of American Pathologists

Payment Qualifications and Requirements

Why are payments being distributed?

Not addressed.

Who will receive payments?

Not addressed.

Definition of ‘Payment’

As emphasized by the HHS, these “are payments, not loans, to health care providers, and will not need to be repaid.”

Where will payments be sent?

Not addressed.

Attestation Requirements

Not addressed.

Where will this payment come from?

Providers will be paid via Automated Clearing House information on file with UnitedHealth Group, UnitedHealthcare, or Optum Bank, or used for reimbursements from the CMS. Providers who usually receive a paper check for reimbursement from the CMS will receive a paper check in the mail for this payment as well.

Conditions for receiving funds

Not addressed.

Payment Allocation

How are payments allocated?

The $30 billion distributed by the HHS will be based on the facility/provider share of the 2019 Medicare fee-for-service reimbursements with payments arriving via direct deposit.

How much will I receive?

Not addressed.

Actions Needed from the Recipient

Within 30 days of receipt of payment, you need to:

Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds.

Terms and Conditions

Within 30 days of receiving the payment, providers must agree to the terms and conditions of payment.

Is this different than the CMS Accelerated and Advance Payment Program?

Not addressed.