Many organizations, government agencies and elected officials are working to address the economic toll of the COVID-19 pandemic. To help you navigate the flood of information, we’ve distilled it down into what we hope are useful key categories. NCMS staff continues to vet and add resources to this page to ensure the latest and most credible content.

Please feel free to reach out to us with questions or clarification at [email protected] or by leaving a voicemail at 919-833-3836. This email and phone line are checked regularly, and we will respond.

Loans to keep your practice going

6/3/2020 – Congressional Action Brings Possible Changes to Paycheck Protection Program

On June 3rd, the US Senate passed the Paycheck Protection Program Flexibility Act of 2020, which the US House of Representatives had passed on May 28. The legislation, which is awaiting President Trump’s signature, includes sweeping changes to the Small Business Administration’s Paycheck Protection Program.

Key provisions in the new bill include that PPP borrowers will now have 24 weeks to use the funds rather than the initial 8-week period. Also, the new rules allow borrowers to apportion 60 percent of the PPP funds toward labor costs, whereas the old rule set the threshold at 75 percent of the loan proceeds. Borrowers also would have five years instead of two to pay off the loan.

The SBA’s PPP webpage has not been updated with any of the new information pending the President’s approval of the legislation. This article from the Journal of Accountancy details more about the changes included in the new legislation.

SBA Extends Deadline to Return PPP Loans to May 14

The U.S. Small Business Administration (SBA) has extended the safe-harbor period for returning Paycheck Protection Program (PPP) funds by one week to May 14. The previous deadline for returning funds (May 7) was initially provided for entities that received PPP funds but then determined that they were unable to certify in good faith that their PPP loan was necessary.

For additional guidance from the SBA, please see question 45 (bottom of page 15) on the FAQ document.

(4/23/2020): Congress passes legislation to provide $484 billion in additional economic relief funds. View the AMA’s summary of the Paycheck Protection Program and Health Care Enhancement Act.

In late March, Congress passed and the president signed the Coronavirus Aid, Relief and Economic Security or CARES Act, a $2 trillion stimulus package, the largest in the nation’s history. Two programs funded by the CARES Act will help doctors and other small businesses meet payroll and fund their business operations during the COVID-19 pandemic.

Financial Guidance from Smith Anderson Amid Covid-19 Crisis

Paycheck Protection Program

  • NEW! (4/29/2020) The most recent federal funding bill set aside a certain amount of funds for Lenders in the $10-$50 billion and < $10 billion asset category, believing that they have more contacts with small businesses. View this list of Lenders in North Carolina (Excel).
  • The Small Business Administration’s (SBA) new Paycheck Protection Program received $350 billion under the CARES Act. Documents from the National Association of Government Guaranteed Lenders (NAGGL), show that this will include forgiveness of the first six month’s loan payments, including principal, interest and fees. This document prepared by the US Chamber of Commerce summarizes the program, which has not yet begun. Now is the time, however, to familiarize yourself with the program if you think it may be helpful. The loans will be made through local lenders in conjunction with the SBA. Read the Chamber’s summary of the program.
  • Here is information from the SBA on this program. The SBA also offers this FAQ Sheet to answer your questions.
  • The NC Bankers Association has this handy one-page explanation of the Paycheck Protection Program. Access it here.
  • Paycheck Protection Program Application.

Economic Injury Disaster Loan Program

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Getting Paid for Your Work Now

The CARES Act Provider Relief Fund

The latest information (4-27-2020) on additional allocations to the CARES Act Provider Relief Fund:

The US Department of Health and Human Services (HHS) has posted new Frequently Asked Questions regarding the second tranche of disbursement of the CARES Act Provider Relief Fund. This document has answers to questions about eligibility for the funds as well as details about how to apply.

Read a detailed description of the entire Provider Relief Fund program.

AMA Guidance on the General Allocation Fund (4-26-2020)

The HHS announced it will begin distributing the second tranche of funds from the $100 billion in funds to hospitals and other health care providers impacted by the coronavirus response. The funding will be used to support health care-related expenses or lost revenue attributable to COVID-19. HHS announced that $50 billion of the Provider Relief Fund is allocated for general distribution to facilities and providers that billed Medicare in 2019, and are impacted by COVID-19, based on providers’ 2018 net patient revenue. Of this $50 billion, the initial $30 billion was distributed between April 10 and April 17, and payments to providers from that $30 billion were calculated based on providers’ portion of Medicare fee-for-service revenue.

Starting on April 24, a portion of providers will automatically be sent an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file will need to submit their revenue information to the General Distribution Portal for additional general distribution funds.

Initially some states and specialties thought that physicians must also submit cost reports, but the AMA verified with HHS that this is not the case. Physicians, however, do need to submit their revenue information so it can be verified via the General Distribution Portal. The portal is now open. The customer service line confirmed anyone who has a Billing TIN (including a pediatric or obstetric practice) who lost revenue in March and/or can estimate lost revenue in April due to the COVID-19 crisis, should be filling out this portal.

The AMA has put together this document on the general allocation portal to help physicians pull together the information they need to submit to the portal. Also, here is additional information on PRF General Distribution Fund. Below are key links from HHS with further explanations on applying through the portal.

The CARES Act Provider Relief Fund — original announcement:

The Department of Health and Human Services (HHS) announced the initial delivery of $30 billion in provider funding as part of the $100 billion Coronavirus Aid, Relief, and Economic Security (CARES) Act. Immediate relief funds began being delivered on Friday April 10 to Medicare enrolled hospitals, physicians and PAs based on their share of 2019 Medicare fee-for-service (FFS) reimbursement. The funds do not need to be paid back.

HHS indicates that “providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.” HHS adds that providers “can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000, and multiply that ratio by $30,000,000,000.”

Additional Disbursements – HHS indicates it is working rapidly on additional targeted distributions, focusing on practices in areas impacted by COVID-19, practices with lower shares of Medicare FFS reimbursement or who predominantly serve Medicaid, and for COVID-19 care for the uninsured.

More information, including the process HHS will use to deliver the funds, can be found in this HHS press release and fact sheet. The HHS website also has information on the Provider Relief Fund.

Medicare’s Accelerated and Advance Payment Program

On April 26, CMS announced a re-evaluation of the Accelerated Payment Program and suspension of the Advance Payment Program.

On April 26, the Centers for Medicare & Medicaid Services (CMS) announced it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to health care providers and suppliers through these programs and in light of the $175 billion recently appropriated for health care provider relief payments.

CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the 2019 Novel Coronavirus (COVID-19). Funding will continue to be available to hospitals and other health care providers on the front lines of the coronavirus response primarily from the Provider Relief Fund. The Accelerated and Advance Payment (AAP) Programs are typically used to give providers emergency funding and address cash flow issues when there is disruption in claims submission or claims processing, including during a public health emergency or Presidentially-declared disaster.

Since expanding the AAP programs on March 28, 2020, CMS approved over 21,000 applications totaling $59.6 billion in payments to Part A providers, which includes hospitals. For Part B suppliers, including doctors, non-physician practitioners and durable medical equipment suppliers, CMS approved almost 24,000 applications advancing $40.4 billion in payments. The AAP programs are not a grant, and providers and suppliers are typically required to pay back the funding within one year, or less, depending on provider or supplier type.

Beginning on April 26, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through the Department of Health & Human Services’ (HHS) Provider Relief Fund.

Significant additional funding will continue to be available to hospitals and other health care providers through other programs. Congress appropriated $100 billion in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (PL 116-136) and $75 billion through the Paycheck Protection Program and Health Care Enhancement Act (PL 116-139) for health care providers. HHS is distributing this money through the Provider Relief Fund, and these payments do not need to be repaid.

For more information on the CARES Act Provider Relief Fund is available above, on this webpage. For information on how to apply, visit: hhs.gov/providerrelief.

For an updated fact sheet on the Accelerated and Advance Payment Programs, visit: https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf

 

Original announcement of Accelerated and Advance Payment programs: The Centers for Medicare and Medicaid Services (CMS) released another $10 billion in Medicare Accelerated and Advance Payments to physicians on Friday, April 10, bringing the week’s total to over $40 billion. These funds are intended to help keep physicians afloat during the disruption in medical services caused by the COVID-19 pandemic.

The funds, authorized in Phase 3 of the COVID-19 response (i.e., the CARES Act), will be repaid through offsetting future Medicare claims. The offsets begin 120 days after disbursement of the funds.

The NCMS is working with the AMA and others to reduce the offset percentage, allowing doctors to keep more of their current Medicare billings and use those funds to recover from the disruption. In addition, the NCMS is supporting elimination of the interest charges on funds retained after the initial advance period.

Learn more here.

This Fact Sheet from the Centers for Medicare and Medicaid Services (CMS) has information on how to submit a request through its Accelerated/Advance Payment Process.

CDC Guidance

ICD-10 coding guidance from the CDC (2/20/2020)

NC Commercial insurers

Medicare/Medicaid

For questions, concerns or input on issues around NC Medicaid and Covid-19 use this email address: [email protected].

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Getting paid for treating the uninsured during COVID-19

The Health Resources and Services Administration (HRSA) recently launched a COVID-19 Uninsured Program Portal where health care providers who have conducted COVID-19 testing of uninsured individuals for COVID-19 or provided treatment to uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020 can request claims for reimbursement.

Providers will be reimbursed, generally at Medicare rates, subject to available funding. Steps will involve:

• Enrolling as a provider participant
• Checking patient eligibility
• Submitting patient information,
• Submitting claims,
• Receiving payment via direct deposit.

To learn more about the program, including the registration and claim submission process, go to COVIDUninsuredClaim.HRSA.gov. HRSA also developed a video overview of the program. In addition, providers can access real-time technical support, as well as service and payment support, by calling the Provider Support Line at 866-569-3522. The hours of operation are 8 a.m. to 8 p.m. Monday through Friday in your local time zone.

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Financial and Practice Management Tools

Medical Practice Financial Template

As revenue decreases, it will be important to closely examine your monthly expenses. If your practice management system is not able to automatically produce a dashboard report, consider utilizing a one-page financial worksheet to get an at-a-glance view of your practice’s financial health. Consider adding comments into the worksheet to explain unusual variances (e.g. vacations and payer problems). This financial worksheet example combines productivity, collections, and expenses into one document. (Courtesy Texas Medical Association).

General Practice Management Guidance for COVID-19

NCMS Business Alliance member Poyner Spruill has compiled numerous resources for employers:

NCMS Business Alliance member Curi has compiled a helpful page of resources, including additional information on telemedicine, practice workflows, disaster planning, helpful webinars and more. Access Curi’s COVID-19 Resource page.

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Other Resources

The Internal Revenue Service has this useful list of actions this agency has taken to give relief during the COVID-19 pandemic. Access that information. Included in that list are details on:

  • The Employee Retention Credit, designed to encourage businesses to keep employees on their payroll. The refundable tax credit is 50 percent of up to $10,000 in wages paid by an eligible employer whose business has been financially impacted by COVID-19. Learn more.
  • Families First Act Act provided paid sick leave and expanded family and medical leave for COVID-19 related reasons and created the refundable paid sick leave credit and the paid child care leave credit for eligible employers. Learn more.

Employers and Unemployment

Paid Sick & Family Leave

Congress passed legislation March 18 (to be enacted no later than April 2, 2020) that created a federal paid sick leave requirement for COVID-19 needs and expanded the Family and Medical Leave Act to include a paid leave component for employees caring for children whose schools or child care facilities were closed because of the virus outbreak. Here are some of the key provisions to consider.

Overview-of-Paid-Sick-Family-Leave-updated.pdf

Tax Implications and Tax Deferrals

For individuals, the April 15th tax filing and payment deadline for 2019 returns has been moved to July 15th. First quarter estimate payments for 2020 are also moved to July 15th. Second quarter estimates are currently still due on June 15th, but this may change. Corporate Income tax due for 2019 as well as 2020 first quarter estimates has also been deferred until July 15th. Underpayment of estimated tax may still apply.

North Carolina has also extended the filing and payment deadline to July 15th. However, under current state law, interest will be accruing on those payments until paid. Again, this may change pending action from the General Assembly. This extension applies to individual, corporate and franchise tax filings and payments.

Currently, there is no deferment on payroll taxes. Businesses need to keep paying payroll taxes as regularly scheduled. Legislation aimed at assisting large employers in under consideration.

Sales Tax- Payments due March 15- March 31 can be deferred until April 15th. Businesses would need to include form 5500 waiver with payment.
https://www.irs.gov/newsroom/filing-and-payment-deadlines-questions-and-answers

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NCMS COVID-19 Resources

COVID-19 QUICK RESOURCES

Covid-19 Information from the NCMS