Q&A: Advance payments

August 15, 2008

Advance payments are available to practices in need of financial help until claims processing issues are resolved.

Q: We continue to have problems with our claims being paid now that we are using only the NPI number to submit. I read where CMS will make payments in advance to practices that are experiencing financial difficulty because of the conversion. How can we apply for those funds?

A: Contact your local carrier to request advance or accelerated payments. Advance payments are made to practices and accelerated payments are made to hospitals. The advance payment to practices is not based upon the amount of claims in processing limbo, but rather on the financial need of the practice until the issues can be resolved. The amount of money advanced is at the discretion of CMS, and the decision cannot be appealed. Advance payment requires that the practice has done everything correctly to ensure that claims will be paid, but the Medicare contractor is unable to process the claims (applied for and received NPIs, correcting misinformation in the NPPES file, removing legacy numbers from claims processing, etc.). The practice is required to submit a statement showing its financial obligations and a statement in writing acknowledging that it owes the money back. Repayment comes in the form of deductions to future payments. Since the advanced amount was not related to outstanding claims, allocating those deductions becomes a bookkeeping headache for your billing staff. This should be a last resort.