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Printed Date: 9/22/2015
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:
An accelerated payment cannot be made if any of the following conditions are met. The provider:
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:
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.
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Last Updated: 01/12/2018