CARES Funding CMS Defines COVID19 Patient Care

QUESTION: We are interested in applying for loans from the CARES Act. While researching the options, we read that the funds are restricted to practices that are providing care for patients with COVID-19. We are an orthopedic practice and caring for patients who may have COVID-19. However, we are not testing patients for the virus. Does that mean we are eligible to receive funds?

Subscriber Question from Houston, TX

ANSWER: Medicare added several stipulations to the funding over the last week. The added wording made many practices question whether they met the new payment strings. So, you are certainly not alone. Although keeping up with the financial rule changes can seem impossible, it is imperative to help you attain needed payment for your practice expenses.

The added HHS eligibility requirements wording that concerned practices indicates:

The Recipient certifies that it billed Medicare in 2019; currently provides 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.

Added stipulations on the usage of funds further made some specialties including orthopedic practices like yours, as well as cardiology, dermatology, rheumatology, and others, doubt that their intended funds usage met the programs criteria. The HHS term requires the following attestation:

The Recipient certifies that the Payment will only be used to prevent, prepare for, and respond to coronavirus, and shall reimburse the Recipient only for health care related expenses or lost revenues that are attributable to coronavirus.

Even if your practice is not actively testing patients for COVID-19, you are caring for patients who may have possible or actual cases of the virus. In addition, your losses in patient volume are due to responding to stay-at-home orders and you will incur expenses and invest in changing your practice’s operations to safely manage patients and staff who may have COVID-19.

After associations including MGMA received numerous queries on the wording, CMS clarified the broad application of the verbiage. In addition, HHS updated the funding eligibility terms to indicate:

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.

Further don’t assume that ceasing operations as a result of COVID-19 means you can’t qualify for the funding. You may still be eligible for funding, provided you meet the generally applicable terms, according to the HHS Provider Relief page.

There are still more hoops to jump through for you to help your practice to secure funding and track its proper usage. Learn the latest financial rules for CARES Act assistance from healthcare attorneys Daphne Kackloudis and Ashley Watson, during their online training session “Keep Your Practice Open Using CARES Funds.”