Request for Accelerated Payment Instruction

Palmetto GBA and the Centers for Medicare & Medicaid Services (CMS) will consider, in limited circumstances, an accelerated payment for Part A and home health and hospice providers who are experiencing financial hardship due to claims that are unable to process within established time limits.

This applies to claims that have been submitted, but payment has not been made due to a system malfunction. This does not apply to claims that have not paid due to claims submission errors.

An accelerated payment may be made if all of the following conditions are met:

• A shortage of cash whereby the provider cannot meet current financial obligations
• The impaired cash position is due to abnormal delays in claims processing and/or payment by the Medicare Administrative Contractor (MAC). However, requests 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 the causes of its billing delays are being corrected and are not chronic.
• 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
• 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
• The MAC is assured that recovery of the payment can be made on a timely basis

An accelerated payment cannot be made if any of the following are true:

• The provider is delinquent in repaying a Medicare overpayment
• The provider has been advised of being under active medical review or program integrity investigation
  
  If you meet all required conditions outlined above and would like to request an accelerated payment, you must submit a Request for Accelerated/Advance Payment form. These forms are available under the Finance/Overpayments section in the Forms tool. The request must be signed by an authorized person, must state the reason your cash balance is seriously impaired, and include financial information to show hardship.
  • JMA — Request for Accelerated/Advance Payment Form 
  • JJA — Request for Accelerated/Advance Payment Form 
  • HHH — Request for Accelerated/Advance Payment

Upon receipt of the request, Palmetto GBA then determines if the provider qualifies for an accelerated payment. If all qualifications are met, the amount of the accelerated payment is calculated and the request is forwarded to CMS for approval. The accelerated payment is calculated as follows:

1. Determine the amount of the interim reimbursement for unbilled and unpaid claims
2. Multiply by 70 percent to determine the net reimbursable amount which can be paid to the provider

If approved, you agree that Palmetto GBA will recover the accelerated payment by applying the amount due to future payments. Recovery of an accelerated payment is made within 90 days after it is issued.

To extent that a delay in the provider’s billing process is the basis for the accelerated payment, recoupment is made by a 100 percent withhold against the provider’s bills processed or other monies due the provider after the date of issuance of the accelerated payment.

The decision to approve an accelerated payment and the amount of the payment is at CMS' discretion and are not subject to review or appeal.

Please note that CMS expects these requests to be limited. In most cases, corrections can be made and claims finalized before an advance payment request can be processed.