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CMS Advanced Payment Program

Please Note: If you are a provider with Atlantic Health Partners, Atlantic Medical Group or Primary Care Partners, your leadership team is actively working with these entities on your behalf. Please contact them for further details.

What is it?

The Centers for Medicare & Medicaid Services (CMS) announced an advanced payment application process to Medicare enrolled clinicians (“providers and suppliers” including physicians and APPs) who have billed Medicare for 180 days prior to their application for advanced payments.  Please note that this is NOT a loan or grant program.

Eligibility:  

Any Medicare provider/supplier (clinician) who has billed the Medicare program for 180 days prior to their application to their Medicare Administrative Contractor (MAC). 

  • The clinician cannot be in Chapter 7, 11, or 13; under active medical review; or a program integrity investigation. 
  • The clinician also cannot be delinquent in repaying Medicare overpayments.

Terms of the Advanced Payments:

The clinician groups may receive up to three months of advanced payments. 

  • Medicare MACs are charged with reviewing and approving applications within seven calendar days of receiving the clinician’s request.
  • Each MAC shall post applications and instructions on their website and electronic submission is encouraged to facilitate the speedy approval of the requests. 
  • It is not known exactly how the MACs will determine the level of advanced payments; in the past advance payment scenarios such as hurricanes and natural disasters the MACs would make estimated payments based on historical payments to a clinician or medical group provider transaction access number (PTAN), (e.g., six to 12 months trailing payment median amounts). This information may become known as the MACs issue instructions on their websites.

Repayment and Recoupment:  

As noted, the advanced payments program is not a grant; repayments must begin 120 days after issuance of the advanced payment.  

  • For Part B clinicians, they will have 210 days total to repay the advanced payments. 
  • Clinicians may continue to submit claims after the advanced payment is made and then the Medicare MACs will begin recouping the advance payments automatically after a 120-day waiting period and then for the next 210 days. 
  • Each MAC has established a hotline number, advanced payments request form and instructions on electronic submissions.