HHS Provider Relief Funding – Update as of 5/11/2020

May 12, 2020
COVID19

HHS has issued the formulas used for the last rounds of targeted allocations; including the $10B Rural Hospital/RHC Distribution and the now $12B High Impact COVID Distribution. Also included below is a quick recap of filing claims for the HRSA COVID 19 uninsured allocation.

$10B Rural Hospital/RHC Distribution

CAH/PPS Rural Hospitals:

Base Payment Calculation: Based on operating expenses from the cost report: Worksheet G3 Line 4

50% of first $2M op exp = $1M
40% of second $2M op exp = $.8M
30% of third $2M op exp = $.6M
20% of fourth $2M op exp = $.4M
10% of fifth $2M op exp = $.2M
…add that up and you get $3M base for 10M op exp
$10M and over is $3M base payment

Add-on to base payment:

2% of operating expense including the base portion (approximate 2%)

Example:

A hospital with $50M operating expense calculation:
$3M base payment plus $1M add-on equals $4M Total Payment
$1M represents 2% of $50M

Rural Health Clinics

Freestanding RHCs: $103,253K each plus a 3.7% ad don payment
Provider-based RHC: No base per RHC, these expenses included in G3 Line 4

Federally Qualified Health Clinics

All Sites located in a rural area will receive $103,253K per site.

$12B High Impact COVID Distribution

$10B Based on Admissions

In response to an HHS request for information, 5,598 hospitals submitted the number of COVID-19 inpatient admissions they encountered through April 10, 2020. In total, 184,037 COVID-19 inpatient admissions were reported.

From this data, HHS identified those facilities with 100 or more COVID-19 admissions. These facilities encountered 129,911 admissions, or over 70% of the total number of COVID-19 inpatient admissions reported. Nationwide, 395 facilities were identified for this distribution; including 18 in Georgia. The number of admissions encountered by these hospitals was then used to determine the allocation of Relief Funds across the pool of eligible recipients. As a result, each recipient received funding equal to $76,975 per admission.

$2B in DSH Payments for Large Medicare/Uninsured Populations

Facilities that serve large Medicare or uninsured populations often do not have the same level of financial resources as other facilities. In recognition of this fact, HHS distributed $2 billion in additional funding to these facilities in proportion to each facility’s share of Medicare Disproportionate Share funding.

Uninsured COVID Reimbursement Portal

We’re aware that HRSA has started issuing the first round of Temporary Patient IDs for requesting reimbursement under the COVID Uninsured Fund. Once you begin receiving those IDs; below is a quick recap on the guide for submitting claims:

All claims must be submitted electronically using an 837 EDI transaction set. Claims will be submitted outside the HRSA COVID-19 Uninsured Program Portal. Include the following information as part of the claim submission, and learn more about EDI via these tools:

You Will Need

Payer ID: 95964 (It’s important to submit claims using the new payer ID 95964 for the program; do not use another payer ID.)
Payer name: COVID19 HRSA Uninsured Testing and Treatment Fund.
Temporary member ID for each patient This information will be found in the program portal after provider submits patient roster.

See coverage details and billing codes for more information on what is covered and coding requirements.

Claims processing timing expectations

EDI claims received each day by 4:00 p.m. ET will be initiated through claims processing at 7:00 a.m ET the next day (day 1). E.g., if claim is submitted at 3:45 p.m. ET on May 20, it will be initiated through claims processing at 7 a.m. ET on May 21.
EDI claims received each day after 4:00 p.m. ET will be initiated through claims processing at 7:00 a.m. ET the following day (day 2). E.g., if claim is submitted at 4:15 p.m. ET on May 20, it will be initiated through claims processing at 7 a.m. ET on May 22.
Claims submitted on a Friday, Saturday or Sunday may take an additional 1-2 days due to weekend processing.

Claim status inquiry and response (X12 276/277) is not available for this program.