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Serving Medicare Patients Last Year May Mean Stimulus Money This Year

May 1, 2020

COVID-19 has wreaked widespread suffering, and the repercussions of the pandemic likely will continue across lives and across the economy for many months to come. Unfortunately, ophthalmologists and their practices are not immune from the fallout. So, naturally, many of us whose practices have been significantly curtailed or even closed are wondering whether we can turn to the Coronavirus Aid, Relief and Economic Security CARES) act, or other stimulus measures, for help.

The answer is, possibly.

The CARES act, the $2 trillion stimulus package passed by Congress and signed by President Donald Trump, created a Public Health and Social Services Emergency Fund that includes $30 billion to be dispersed by the Centers for Medicare & Medicaid Services. The money is intended to help providers keep their doors open and workers on the payroll while business has slowed, or even stopped, due to the pandemic. And the payments are just that, payments – not loans that must be paid back.

According to the American Academy of Ophthalmology, those eligible for payment include:

  • Facilities and providers who received Medicare fee-for-service (FFS) reimbursements in 2019.
  • Providers who agree not to seek out-of-pocket payments from COVID-19 patients that are greater than they would be if the patient had received care from an in-network provider.

Payments to providers will be based on their 2019 Medicare FFS reimbursements. In addition, the AAO has stated it believes payments will include Medicare Part B medication reimbursements.

Of course, there are conditions and strings attached. Payment can only be used for lost revenue or expenses related to the COVID-19 virus. Any provider who wants to receive payments must agree to a set of conditions within 30 days. Further, any provider who receives more than $150,000 must report to Health and Human Services and to the Pandemic Response Accountability Committee on how the funds were used.

In most cases, such as employed physicians and physicians in group practice, physicians will not receive direct individual payments. Instead, money will go to the employing or billing organization.

The exception to this is solo practitioners.

Another piece of legislation, the Families First Coronavirus Response Act, includes provisions that require some employers to provide paid sick leave, paid family and medical leave, when that time off is connected to the coronavirus. According to the U.S. Department of Labor, the pay for that required family leave is capped at various amounts per employee, depending on the precise reason for the leave. The provision is effective through the end of the year.

Some workers also may be eligible for additional weeks of unemployment benefits, beyond the payments provided by state programs, through December 31.

The act also calls for tax credits for the paid leave, and expansion of unemployment insurance.

For more information on the Families First Coronavirus Response Act, visit the Department of Labor website at: https://www.dol.gov/agencies/whd/pandemic/ffcra-questions.

Finally, there is a bit of good news for any physicians still paying off student loans: payments, principal and interest are deferred through Sept. 30.

Hopefully these and other provisions can help reduce the economic pain caused by the COVID-19 pandemic.

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