Accelerated and Advance Payments
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May 10, 2016

Accelerated and Advance Payments

In certain circumstances where a provider is experiencing financial difficulty due to delays in receiving payment for Medicare services provided, they may be eligible for an accelerated or advance payment. However, delays caused by claim submission errors do not qualify, and in most cases claim payment issues identified are resolved more quickly than such a request can be made and processed.

An advance is a conditional partial payment for services rendered and must be used for Provider operations in the ordinary course of business. It must be repaid timely when the qualifying payment or billing issues have been resolved. An accelerated payment must also be repaid within 90 days or it becomes a delinquent Medicare overpayment subject to recoupment, interest charges, and referral to Treasury.

Providers may not request an accelerated or advance payment if they are delinquent in repaying a Medicare overpayment or have been advised that they are under an active medical review or program integrity investigation. If the provider is determined to be eligible, the amount of the payment is based on a percentage of the net reimbursement for unbilled or unpaid covered services. Decisions and payment amounts are at the discretion of CMS and are not subject to review or appeal.

Provider eligibility for accelerated payments is contingent on the provider meeting all of the following conditions:

  • A shortage of cash exists whereby the provider cannot meet current financial obligations; and
  • The impaired cash position is due to abnormal delays in claims processing and/or payment by the Medicare Administrative Contractor (MAC). 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 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 timely.

Similarly, eligibility requirements for advance payments include the following:

  • The MAC is unable to process the claim timely; and
  • CMS determines that the prompt payment interest provision specified in section 1842© of the Act is insufficient to make a claimant whole; and
  • CMS provides written approval of an advance payment to the MAC.

When a provider has confirmed that all requirements have been met, they may submit a request for an accelerated or advance payment as follows:

  • Complete an Accelerated or Advance Payment Request FormPDF, which must be certified by the provider's CEO or CFO.
  • Provide supporting documentation for the amount requested, such as claim information, balance sheet and income statements.

Documentation or questions can be submitted via e-mail CGS.ERS.CORR@cgsadmin.com, fax 615-664-5949 or mail:

CGS Administrators, LLC
ATTN: CFO Accelerated Payments
PO Box 20018
Nashville TN 37202

For additional guidance, refer to the Medicare Financial Management Manual, (Pub. 100-06), Chapter 3, Section 150; Chapter 24, Section 2412 of the Provider Reimbursement Manual; or 42 CFR 421.214.


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