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COVID-19 Practice Financial Assistance

Last updated 5/26/2020

ACP recommends transitioning all non-urgent patients who do not need to be seen in person to virtual visits, or delaying their visits during the national emergency created by COVID-19. The direction was provided as part of a new policy “Statement on Nonurgent In-Person Medical Care.”

There are several mechanisms in the CARES Act to assist in mitigating financial shortfalls due to COVID-19:

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  • CARES Act Relief Fund Payments provide funds to hospitals, physicians, and other healthcare entities.  These are payments, not loans, so recipients will not need to be pay them back.  These FAQs seek to clarify some of the confusion regarding this program, especially how to calculate the amount due and how to reject a payment.
    • General Allocation:
      • The 1st distribution of these payments arrived via direct deposit on April 10 or April 17.  Electronic payments were automatic payments via OptumBank and are labeled “HHSPAYMENT”.  (Paper checks will be mailed in coming weeks.) 
        • Payments were paid to the TIN that usually receives Medicare payments (such as the group practice, the employing entity, or billing company). 
        • This first payment was based on a share of Medicare fee-for-service reimbursements in 2019.
      • The 2nd distribution of payments began on April 24.
        • For more information about how to apply, read the Relief Fund Application Guide  and the FAQs about the program.  Before you begin, you will need:  to have attested to receipt of the 1st round and the amount received (including transaction or check number), a PDF of your most recent filed tax return (2018 or 2019), and an estimate of lost revenues for March and April.  You will also need your TIN (and the TINs of any subsidiaries that received funds) and your Medicare or Medicaid ID.
      • Facilities and practices who receive a payment from this general allocation must sign an attestation confirming receipt of the funds and agree to the terms and conditions within 90 days of payment.  
        • Note that there are some restrictions attached, such as the requirement to accept in-network fees for services provided to patients (no balance billing).
    • Targeted Allocations:
      • Beginning May 7, 2020, Medicare will pay physicians who have provided testing or treatment for uninsured patients with COVID-19 on or after February 4. For more information on how to enroll, determine patient eligibility, submit claims, and receive payment via direct deposit, the uninsured program portal is now open. 
      • Hospitals in High Impact Areas:  Hospitals deemed eligible for these funds were contacted directly.
      • Rural Health Clinics and Hospitals: These organizations will be allocatedthese payments directly, based on their operating expenses.
      • Indian Health Service Facilities: These organizations will be allocated these payments directly, based on their operating expenses.
      • Additional allocations are coming soon:  These are expected to be targeted to “providers,” likely including physician practices, that rely on Medicaid.  More information will be provided once it becomes available.
  • The Accelerated and Advance Payment Program was suspended as of April 26. 
    • For those who received payments through this program, this FAQ explains the payback terms. 
    • ACP and other medical societies are advocating to bring this program back as well as improve payback terms to prevent further deferred cash flow problems.
  • The Paycheck Protection Program (PPP) and the Economic Injury Disaster Loan (EIDL) emergency advance, which are managed by the Small Business Administration (SBA), offer low-interest loans to small businesses to cover payroll, benefits, rent, mortgage, utilities, and other business expenses.  
    • Loan forgiveness applications: The SBA released an application to submit to lenders when seeking loan forgiveness. The application contains instructions, a PPP Loan Forgiveness Calculation Form, and the PPP Schedule A (including a PPP Schedule A Worksheet).
    • This fact sheet for borrowers and FAQs from the Department of Treasury provide a lot of guidance and clarification on the PPP loan program. 
    • EIDL applicants who have already submitted their applications will continue to be processed on a first-come, first-served basis.
    • This updated loan forgiveness calculator from the AICPA, can be used to help practices determine what the amount of forgiveness will be for PPP loans.
  • There are some tax benefits available to employers, including medical practices, designed to keep employees on the payroll.  [Note: It is important to talk to your accountant or financial advisor about the different programs, as some do interact with or are contraindicated with the above PPP loans.]  
    • Employee Retention Credit - The Employee Retention Credit is a fully refundable tax credit for employers equal to 50% of qualified wages (including allocable qualified health plan expenses) that Eligible Employers pay their employees. The IRS has issued some FAQs on the Employee Retention Credit, including eligibility, payback, and the interaction with the PPP.
    • Payroll tax deferral - Allows employers to defer the deposit and payment of the employer's share of social security taxes and self-employed individuals to defer payment of certain self-employment taxes.  
    • The CARES Act also includes provisions related to student loans.  Under the law, no federal student loans are required between March 13 and September 30, 2020, and interest will drop to zero during that time period.  In addition, employers can pay up to $5,250 toward an employee’s student loans tax-free through the end of the year. Normally, these payments are treated as wages, but until December 31, 2020, these payments can be excluded from income and payroll taxes – benefitting both the employer and those receiving the repayment assistance.