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Medicare Proposed Rule for FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and
Long-Term
Care Hospitals (LTCH PPS) 

04.20.23

Release Date: April 10, 2023
Federal Register Publication Date: Scheduled for May 1, 2023
Effective Date: October 1, 2023 
Comment Period Ends: June 9, 2023

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates Medicare payment rates and policies for inpatient hospitals and long-term care hospitals for the fiscal year 2024, as well as other provisions. Following is a summary of the major provisions of this proposed rule.

IPPS payment rates:
CMS proposed a net increase in FY 2024 Medicare IPPS rates of 2.8% for hospitals that are meaningful users of electronic health records and submit required quality data. The increase is broken down as follows:

The proposed rule would increase hospital payments by $3.3 billion, less a proposed decrease in disproportionate share hospital payments of $115 million and a proposed decrease of $460 million in new medical technology payments.

LTCH PPS payment rates:
CMS proposed a net increase in FY 2024 Medicare LTCH PPS rate of 2.9% for long-term care hospitals, comprised of a market basket increase of 3.1% less the productivity adjustment of 0.2%. The proposed payment rate projects a 4.7% decrease in high-cost outlier payments as a percentage of the total LTCH PPS standard Federal payment rate. CMS estimates that LTCH PPS payments will decrease approximately $59 million as a result of the proposed FY 2024 payment update.

Other major provisions proposed:

  • Proposed revisions to the wage index for acute care hospitals and annual update of the wage data, including:
    • FY2024 wage index update using wage data from cost reporting periods beginning in FY2019. 
    • Occupational mix adjustment based on FY2019 survey.
    • Continuation of the temporary policy for low-wage index hospitals
    • To include rural classified hospitals and geographically rural hospitals for the purposes of calculating the wage index and to exclude “dual reclass” hospitals. Changes to the rural wage index will affect the rural floor. 
    • Adjustment to the wage index for FY2023 based on commuting patterns of hospital employees who reside in a county and work in a different area with a higher wage index. 
  • Rural Emergency Hospitals proposed to serve as training sites for graduate medical training for an opportunity to receive Medicare GME payments. This was proposed among the concerns over closures of rural hospitals. 
  • Proposed to change the effective date of rural reclassification for a hospital qualifying for rural classification by meeting the criteria for SCH status or also applying to obtain SCH status based on eligibility from hospital merger. 
  • Proposed regulations for Physician Owned Hospitals who satisfy all the requirements of either the whole hospital exception or the rural provider exception to the physician self-referral law (Stark Law). 
    • CMS to consider expansion exception requests to expand facility capacity for eligible hospitals. 
    • Reinstate program integrity restrictions on the frequency of expansion exception requests for hospitals who meet the criteria for “high Medicaid facilities”. 
  • Proposed adjustments to Nursing and Allied Health education payments associated with Medicare Advantage enrollees, including a method for the MACs to implement the “Wavier on Cap on Annual Payments for Nursing and Allied Health Education Payments” for each of 2010 through 2019. 
  • Proposed changes to Medicare Promoting Interoperability Program for eligible hospitals:
    • Safety Assurance Factors for EHR Resilience (SAFER) guides to require eligible hospitals and CAHs to attest “yes” to having a self-assessment conducted of all nine SAFER guides during the calendar year in which the EHR reporting period occurs to satisfy meaningful use. 
    • EHR reporting period for a payment adjustment year to be defined as a minimum of any continuous 180-day period within CY 2025. 
    • Three new eCQMs proposed to be selected as one of the self-selected eCQMs beginning of CY2025 reporting period:
      • Hospital Harm – Pressure Injury
      • Hospital Harm – Acute Kidney Injury
      • Excessive Radiation Dose or Inadequate Image Quality for Diagnostic CT in Adults (Hospital Level – Inpatient)
  • For HAC Reduction Program, CMS proposes to establish a validation reconsideration process, providing hospitals with an opportunity to request reconsideration of their final validation score prior to HAC Reduction Program scoring, beginning with FY2025 program year and future years. Also, CMS proposes modification of the validation criteria to address extraordinary circumstances exceptions beginning with the FY2027 program year, affecting 2024 discharges. 
  • In the Hospital Value-Based Purchasing (VBP) program, one new measure is proposed to add technical changes to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey as well as change the scoring policy to include a health equity scoring adjustment. This would modify the Total Performance Score (TPS) maximum to be 110 giving a numeric range of 0 to 110. 
  • Three new measures proposed for Hospital IQR Program to update three existing measures and remove three measures. The changes are proposed to the validation process. 
    • Remove the hospital-level risk-standardized complication rate following elective primary total hip arthroplasty and/or total knee arthroplasty measure from Hospital IQR Program with a proposed updated measure in the Hospital VBP Program. 
    • Medicare Spending per beneficiary (MSPB) hospital measure to be removed and adopt a proposed updated measure in the Hospital VBP Program. 
    • Remove the elective delivery prior to 39 completed weeks gestation measure (PC-01) as performance is so high and unvarying that improvements in performance can no longer be made. 

Sources: 
CMS-1785-P Medicare Program; Proposed Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2024 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Rural Emergency Hospital and Physician-Owned Hospital Requirements; and Provider and Supplier Disclosure of Ownership 

 

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Read this if you are an IT Leader, CFO, COO, or other C-suite leader responsible for selecting a new system.

Vendor demonstrations are an important milestone in the vendor selection process for organizations assessing new software systems. Demonstrations allow you to validate what a vendor’s software is capable of, evaluate the usability with your own eyes, and confirm the fit to your organization’s objectives.

Pre-COVID-19, such demonstrations would generally take place in person. During the middle of COVID-19, remote demos were the only option. Today, organizations have choices between in-person or remote demos. Given staffing challenges and vendor schedules, remote demos can be more efficient and flexible and are a choice worth considering.

Here are some of the key success factors and lessons learned we found conducting and completing remote demonstrations.

  1. Prepare thoroughly for your remote software demo
    Establish a clear agenda, schedule, script, and plan prior to demonstrations. This helps keep everyone coordinated throughout the demos.
  2. Test the software vendor’s videoconference system
    It’s important to test the vendor’s videoconference solution from all locations prior to the demonstrations. We test with vendors a week in advance.
  3. Establish ground rules for the demo
    Establishing ground rules enhances meeting effectiveness, efficiency, and timeliness. For example, should questions be asked as they come up, or should participants wait until the speaker pauses? Should the chat function be utilized instead?
  4. Have clear roles by location
    Clear roles help to facilitate the demonstration. Designated timekeepers, scribes, and local facilitators help the demonstration go smoothly, and decrease communication issues.
  5. Be close to the microphone
    This is common sense, but when you’re in a virtual environment and you may not be on screen, be sure that you’re close to the microphone and are speaking clearly so everyone can hear you.
  6. Ask vendors to build in pauses to allow for questions
    Since vendors may not be able to see a hand raised, asking vendors to build specific pauses into their demonstrations allows space for questions to be asked easily. Consider designating a team member to monitor for hands raised and to interject so that a question can be asked in a timely manner.
  7. Do a virtual debrief
    At the end of each vendor demonstration, we have our own virtual meeting set up to facilitate a debrief. This allows us to capture the evaluation notes of the day prior to the next demo. Planning these in advance and having them on people’s calendars makes joining the meetings quick and seamless.

Observations and other lessons learned from remote vendor demos

After facilitating many remote software vendor demos, we’ve identified these lessons learned unique to virtual demos. 

Visibility is actually better with remote demos
Virtual demos allow everyone to see the demo on their own screen, which actually makes it easier to see than if you were doing the demo on-site. 

Different virtual platforms require orientation
We want vendors to use the tools they are accustomed to using, which means we need to use different products for different demonstrations. This is not insurmountable, but requires orientation to get used to their tools at the start of each demo.

Establishing the order in which team members provide feedback is useful
It’s helpful to establish an order in which participants speak and share their thoughts. This limits talking over each other and allows everyone to hear the thoughts of their peers clearly.

Staying engaged takes effort
Sitting all day on a remote demo and paying attention requires effort to stay engaged. Building in specific times for Q&A, calling on people by name, and designing the day with breaks can help people stay engaged all day.

Remote software demos can be highly successful, accomplish your goals, and help you meet critical timing milestones. We’ve found that post-COVID-19 when remote demos follow the guidelines above, they are often more efficient and engaging than if they had been conducted on-site. If you need assistance in implementing a healthcare IT solution, our team would be happy to help. Learn about our services. 

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Hosting efficient and engaging remote vendor demonstrations for software solutions

Do you know what would happen to your company if your CEO suddenly had to resign immediately for personal reasons? Or got seriously ill? Or worse, died? These scenarios, while rare, do happen, and many companies are not prepared. In fact, 45% of US companies do not have a contingency plan for CEO succession, according to a 2020 Harvard Business Review study.  

Do you have a plan for CEO succession? As a business owner, you may have an exit strategy in place for your company, but do you have a plan to bridge the leadership gap for you and each member of your leadership team? Does the plan include the kind of crises listed above? What would you do if your next-in-line left suddenly? 

Whether yours is a family-owned business, a company of equity partners, or a private company with a governing body, here are things to consider when you’re faced with a situation where your CEO has abruptly departed or has decided to step down.  

1. Get a plan in place. First, assess the situation and figure out your priorities. If there is already a plan for these types of circumstances, evaluate how much of it is applicable to this particular circumstance. For example, if the plan is for the stepping down or announced retirement of your CEO, but some other catastrophic event occurs, you may need to adjust key components and focus on immediate messaging rather than future positioning. If there is no plan, assign a small team to create one immediately. 

Make sure management, team leaders, and employees are aware and informed of your progress; this will help keep you organized and streamline communications. Management needs to take the lead and select a point person to document the process. Management also needs to take the lead in demeanor. Model your actions so employees can see the situation is being handled with care. Once a strategy is identified based on your priorities, draft a plan that includes what happens now, in the immediate future, and beyond. Include timetables so people know when decisions will be made.  

2. Communicate clearly, and often. In times of uncertainty, your employees will need as much specific information as you can give them. Knowing when they will hear from you, even if it is “we have nothing new to report” builds trust and keeps them vested and involved. By letting them know what your plan is, when they’ll receive another update, what to tell clients, and even what specifics you can give them (e.g., who will take over which CEO responsibility and for how long), you make them feel that they are important stakeholders, and not just bystanders. Stakeholders are more likely to be strong supporters during and after any transition that needs to take place. 

3. Pull in professional help. Depending on your resources, we recommend bringing in a professional to help you handle the situation at hand. At the very least, call in an objective opinion. You’ll need someone who can help you make decisions when emotions are running high. Bringing someone on board that can help you decipher what you have to work with and what your legal and other obligations may be, help rally your team, deal with the media, and manage emotions can be invaluable during a challenging time. Even if it’s temporary. 

4. Develop a timeline. Figure out how much time you have for the transition. For example, if your CEO is ill and will be stepping down in six months, you have time to update any existing exit strategy or succession plan you have in place. Things to include in the timeline: 

  • Who is taking over what responsibilities? 
  • How and what will be communicated to your company and stakeholders? 
  • How and what will be communicated to the market? 
  • How will you bring in the CEO's replacement, while helping the current CEO transition out of the organization? 

If you are in a crisis situation (e.g., your CEO has been suddenly forced out or asked to leave without a public explanation), you won’t have the luxury of time.  

Find out what other arrangements have been made in the past and update them as needed. Work with your PR firm to help with your change management and do the right things for all involved to salvage the company’s reputation. When handled correctly, crises don’t have to have a lasting negative impact on your business.   

5. Manage change effectively. When you’re under the gun to quickly make significant changes at the top, you need to understand how the changes may affect various parts of your company. While instinct may tell you to focus externally, don’t neglect your employees. Be as transparent as you possibly can be, present an action plan, ask for support, and get them involved in keeping the environment positive. Whether you bring in professionals or not, make sure you allow for questions, feedback, and even discord if challenging information is being revealed.  

6. Handle the media. Crisis rule #1 is making it clear who can, and who cannot, speak to the media. Assign a point person for all external inquiries and instruct employees to refer all reporter requests for comment to that point person. You absolutely do not want employees leaking sensitive information to the media. 
 
With your employees on board with the change management action plan, you can now focus on external communications and how you will present what is happening to the media. This is not completely under your control. Technology and social media changed the game in terms of speed and access to information to the public and transparency when it comes to corporate leadership. Present a message to the media quickly that coincides with your values as a company. If you are dealing with a scandal where public trust is involved and your CEO is stepping down, handling this effectively will take tact and most likely a team of professionals to help. 

Exit strategies are planning tools. Uncontrollable events occur and we don’t always get to follow our plan as we would have liked. Your organization can still be prepared and know what to do in an emergency situation or sudden crisis.  Executives move out of their roles every day, but how companies respond to these changes is reflective of the strategy in place to handle unexpected situations. Be as prepared as possible. Own your challenges. Stay accountable. 

BerryDunn can help whether you need extra assistance in your office during peak times or interim leadership support during periods of transition. We offer the expertise of a fully staffed accounting department for short-term assignments or long-term engagements―so you can focus on your business. Meet our interim assistance experts.

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Crisis averted: Why you need a CEO succession plan today

Read this if your CFO has recently departed, or if you're looking for a replacement.

With the post-Covid labor shortage, “the Great Resignation,” an aging workforce, and ongoing staffing concerns, almost every industry is facing challenges in hiring talented staff. To address these challenges, many organizations are hiring temporary or interim help—even for C-suite positions such as Chief Financial Officers (CFOs).

You may be thinking, “The CFO is a key business partner in advising and collaborating with the CEO and developing a long-term strategy for the organization; why would I hire a contractor to fill this most-important role?” Hiring an interim CFO may be a good option to consider in certain circumstances. Here are three situations where temporary help might be the best solution for your organization.

Your organization has grown

If your company has grown since you created your finance department, or your controller isn’t ready or suited for a promotion, bringing on an interim CFO can be a natural next step in your company’s evolution, without having to make a long-term commitment. It can allow you to take the time and fully understand what you need from the role — and what kind of person is the best fit for your company’s future.

BerryDunn's Kathy Parker, leader of the Boston-based Outsourced Accounting group, has worked with many companies to help them through periods of transition. "As companies grow, many need team members at various skill levels, which requires more money to pay for multiple full-time roles," she shared. "Obtaining interim CFO services allows a company to access different skill levels while paying a fraction of the cost. As the company grows, they can always scale its resources; the beauty of this model is the flexibility."

If your company is looking for greater financial skill or advice to expand into a new market, or turn around an underperforming division, you may want to bring on an outsourced CFO with a specific set of objectives and timeline in mind. You can bring someone on board to develop growth strategies, make course corrections, bring in new financing, and update operational processes, without necessarily needing to keep those skills in the organization once they finish their assignment. Your company benefits from this very specific skill set without the expense of having a talented but expensive resource on your permanent payroll.

Your CFO has resigned

The best-laid succession plans often go astray. If that’s the case when your CFO departs, your organization may need to outsource the CFO function to fill the gap. When your company loses the leader of company-wide financial functions, you may need to find someone who can come in with those skills and get right to work. While they may need guidance and support on specifics to your company, they should be able to adapt quickly and keep financial operations running smoothly. Articulating short-term goals and setting deadlines for naming a new CFO can help lay the foundation for a successful engagement.

You don’t have the budget for a full-time CFO

If your company is the right size to have a part-time CFO, outsourcing CFO functions can be less expensive than bringing on a full-time in-house CFO. Depending on your operational and financial rhythms, you may need the CFO role full-time in parts of the year, and not in others. Initially, an interim CFO can bring a new perspective from a professional who is coming in with fresh eyes and experience outside of your company.

After the immediate need or initial crisis passes, you can review your options. Once the temporary CFO’s agreement expires, you can bring someone new in depending on your needs, or keep the contract CFO in place by extending their assignment.

Considerations for hiring an interim CFO

Making the decision between hiring someone full-time or bringing in temporary contract help can be difficult. Although it oversimplifies the decision a bit, a good rule of thumb is: the more strategic the role will be, the more important it is that you have a long-term person in the job. CFOs can have a wide range of duties, including, but not limited to:

  • Financial risk management, including planning and record-keeping
  • Management of compliance and regulatory requirements
  • Creating and monitoring reliable control systems
  • Debt and equity financing
  • Financial reporting to the Board of Directors

If the focus is primarily overseeing the financial functions of the organization and/or developing a skilled finance department, you can rely — at least initially — on a CFO for hire.

Regardless of what you choose to do, your decision will have an impact on the financial health of your organization — from avoiding finance department dissatisfaction or turnover to capitalizing on new market opportunities. Getting outside advice or a more objective view may be an important part of making the right choice for your company.

BerryDunn can help whether you need extra assistance in your office during peak times or interim leadership support during periods of transition. We offer the expertise of a fully staffed accounting department for short-term assignments or long-term engagements―so you can focus on your business. Meet our interim assistance experts.

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Three reasons to consider hiring an interim CFO

Editor's note: read this if you are a CFO, controller, accountant, or business manager.

We auditors can be annoying, especially when we send multiple follow-up emails after being in the field for consecutive days. Over the years, we have worked with our clients to create best practices you can use to prepare for our arrival on site for year-end work. Time and time again these have proven to reduce follow-up requests and can help you and your organization get back to your day-to-day operations quickly. 

  1. Reconcile early and often to save time.
    Performing reconciliations to the general ledger for an entire year's worth of activity is a very time consuming process. Reconciling accounts on a monthly or quarterly basis will help identify potential variances or issues that need to be investigated; these potential variances and issues could be an underlying problem within the general ledger or control system that, if not addressed early, will require more time and resources at year-end. Accounts with significant activity (cash, accounts receivable, investments, fixed assets, accounts payable and accrued expenses and debt), should be reconciled on a monthly basis. Accounts with less activity (prepaids, other assets, accrued expenses, other liabilities and equity) can be reconciled on a different schedule.
  2. Scan the trial balance to avoid surprises.
    As auditors, one of the first procedures we perform is to scan the trial balance for year-over-year anomalies. This allows us to identify any significant irregularities that require immediate follow up. Does the year-over-year change make sense? Should this account be a debit balance or a credit balance? Are there any accounts with exactly the same balance as the prior year and should they have the same balance? By performing this task and answering these questions prior to year-end fieldwork, you will be able to reduce our follow up by providing explanations ahead of time or by making correcting entries in advance, if necessary. 
  3. Provide support to be proactive.
    On an annual basis, your organization may go through changes that will require you to provide us documented contractual support.  Such events may include new or a refinancing of debt, large fixed asset additions, new construction, renovations, or changes in ownership structure.  Gathering and providing the documentation for these events prior to fieldwork will help reduce auditor inquiries and will allow us to gain an understanding of the details of the transaction in advance of performing substantive audit procedures. 
  4. Utilize the schedule request to stay organized.
    Each member of your team should have a clear understanding of their role in preparing for year-end. Creating columns on the schedule request for responsibility, completion date and reviewer assigned will help maintain organization and help ensure all items are addressed and available prior to arrival of the audit team. 
  5. Be available to maximize efficiency. 
    It is important for key members of the team to be available during the scheduled time of the engagement.  Minimizing commitments outside of the audit engagement during on site fieldwork and having all year-end schedules prepared prior to our arrival will allow us to work more efficiently and effectively and help reduce follow up after fieldwork has been completed. 

Careful consideration and performance of these tasks will help your organization better prepare for the year-end audit engagement, reduce lingering auditor inquiries, and ultimately reduce the time your internal resources spend on the annual audit process. See you soon. 

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Save time and effort—our list of tips to prepare for year-end reporting

Read this if you are an employee benefit plan fiduciary.

This article is the second in a series to help employee benefit plan fiduciaries better understand their responsibilities and manage the risks of non-compliance with Employee Retirement Income Security Act (ERISA) requirements. In our last article, we looked into the background of ERISA, which established important standards for the sound operation of employee benefit plans, as well as who is and isn’t a plan fiduciary, and what their responsibilities are. 

One important ERISA provision, found in Section 406(a), covers the types of transactions a plan fiduciary can and can’t engage in. ERISA terms the latter prohibited transactions, and they’re a lot like traffic lights—when it comes to avoiding conflicts of interest in business dealings, they’re your guide for when to stop and when to go. By knowing and abiding by these rules of the road, plan fiduciaries can steer clear of tickets, fines, and other damaging mishaps. 

Parties-in-interest—keep them out of the passenger seat 

Much like driver’s ed., fiduciary responsibility boils down to knowing the rules—plan fiduciaries need to have a strong working knowledge of what constitutes a prohibited transaction in order to ensure their compliance with ERISA. The full criteria are too detailed for this article, but one sure sign is the presence of a party-in-interest.

ERISA’s definition of a party-in-interest

The definition includes any plan fiduciary, the plan sponsor, its affiliates, employees, and paid and unpaid plan service providers, and 50%-or-more owners of stock in the plan sponsor. If you’d like to take a deeper dive into ERISA’s definition of parties-in-interest, see “ERISA's definition of parties-in-interest" at right.

Prohibited transactions—red lights on fiduciary road 

Now that we know who fiduciaries shouldn’t transact with, let’s look at what they shouldn’t transact on. ERISA’s definition of a prohibited transaction includes: 

  • Sale, exchange, and lease of property 
  • Lending money and extending credit 
  • Furnishing goods, services, and facilities 
  • Transferring plan assets 
  • Acquiring certain securities and real property using plan assets to benefit the plan fiduciary 
  • Transacting on behalf of any party whose interests are adverse to the plan’s or its participants’ 

Transacting in any of the above is akin to running a red light—serious penalties are unlikely, but there are other consequences you want to avoid. Offenders are subject to a 15% IRS-imposed excise tax that applies for as long as the prohibited transaction remains uncorrected. That tax applies regardless of the transaction’s intent and even if found to have benefited the plan. 

The IRS provides a 14-day period for plan fiduciaries to correct prohibited transactions and avoid associated penalties. 

Much like owning a car, regular preventative maintenance can help you avoid the need for costly repairs. Plan fiduciaries should periodically refresh their understanding of ERISA requirements and re-evaluate their current and future business activities on an ongoing basis. Need help navigating the fiduciary road? Reach out to the BerryDunn employee benefit consulting team today. 
 

Article
Prohibited transactions: Rules of the road for benefit plan fiduciaries

Read this if your organization, business, or institution is receiving financial assistance as a direct result of the COVID-19 pandemic.

For companies and organizations that received federal funding to assist them during the COVID-19 pandemic, there have been some updates on Uniform Guidance. Here is a brief summary of those updates, audit threshold, federal funds subject to that threshold, and other pertinent information regarding the guidance.

Audit threshold

Non-federal entities that expend federal funds of $750,000 or more are required to have an audit in accordance with Subpart F of Title 2, U.S. Code of Federal Regulations, Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance).

Funds subject to threshold

  • 93.498 Provider Relief Fund
  • 21.019 Coronavirus Relief Fund
  • 84.425 Higher Education Stabilization Fund
  • 32.006 COVID-19 Telehealth Program
  • 84.184C CARES Act Project SERV
  • 93.461 COVID-19 Testing for the Uninsured
  • 93.527 Grants for New and Expanded Services under Health Center Program
  • 93.665 Emergency Grants to Address Mental and Substance Use Disorders During COVID-19
  • 93.967 COVID-19 Testing for Rural Health Clinics

Funds exempt from threshold

  • 59.073 (Small Business Administration) Payroll Protection Loan Program
  • 59.072 Economic Injury Disaster Loan Emergency Advance

Audit options

  • Single Audit in accordance with Uniform Guidance
  • Program-specific audit (only applicable if the non-federal entity expends Federal awards under one single CFDA)

Reporting timetables

  • Automatic three-month audit submission extension for Single Audits of 2020 year-ends through September 30, 2020 (only if recipient received some form of COVID-19 funding subject to Uniform Guidance)
    • Example, a June 30, 2020 year-end’s initial date is March 31, 2021, however this was extended to June 30, 2021

Compliance supplement addendum takeaways

  • Released December 22, 2020
  • Provides guidance on auditing above CFDAs
  • For organizations with year-ends prior to December 31, 2020, above funding will be reported in the Schedule of Expenditures of Federal Awards (SEFA) for fiscal years ending in 2021

For-profit considerations

  • Department of Health and Human Services (HHS) has determined for-profit commercial organizations (which envelopes hospitals, senior living facilities, and other health facilities) are required to include PRF payments in determining the $750,000 threshold for a compliance audit requirement
  • Currently, HHS guidance makes reference to organizations “receiving” not “expending” PRF, which is not in line with current Uniform Guidance definitions – AICPA has reached out for clarification
  • There is a third option under HHS guidance for organizations to have a financial audit performed in accordance with US generally accepted auditing standards and US generally accepted governmental auditing standards. However, there is uncertainty as to the specifics of this option and if this option would receive reporting extensions discussed above – AICPA has reached out for clarification

If you have questions about accounting for, or reporting on, funds that you have received as a result of the COVID-19 pandemic, please contact a member of our Single Audit Team. We’re here to help.

Article
Uniform Guidance—where we are today

The COVID-19 emergency has caused CMS (Centers for Medicare & Medicaid Services) to expand eligibility for expedited payments to Medicare providers and suppliers for the duration of the public health emergency.

Accelerated payments have been available to providers/suppliers in the past due to a disruption in claims submission or claims processing, mainly due to natural disasters. Because of the COVID-19 public health emergency, CMS has expanded the accelerated payment program to provide necessary funds to eligible providers/suppliers who submit a request to their Medicare Administrative Contractor (MAC) and meet the required qualifications.

Eligibility requirements―Providers/suppliers who:

  1. Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form,
  2. Are not in bankruptcy,
  3. Are not under active medical review or program integrity investigation, and
  4. Do not have any outstanding delinquent Medicare overpayments.

Amount of payment:
Eligible providers/suppliers will request a specific amount for an accelerated payment. Most providers can request up to 100% of the Medicare payment amount for a three-month period. Inpatient acute care hospitals and certain other hospitals can request up to 100% of the Medicare payment amount for a six-month period. Critical access hospitals (CAHs) can request up to 125% of the Medicare payment for a six-month period.

Processing time:
CMS has indicated that MACs will work to review and issue payment within seven calendar days of receiving the request.

Repayment, recoupment, and reconciliation:
The December 2020 Bipartisan-Bicameral Omnibus COVID Relief Deal revised the repayment, recoupment and reconciliation timeline on the Medicare Advanced and Accelerated Payment Program as identified below. 

Hospitals repayment, recoupment and reconciliation timeline 
Original Timeline 
Time from date of payment receipt  Recoupment & Repayment
120 days  No payments due 
121 - 365 days  Medicare claims reduced by 100% 
> 365 days provider may repay any balance due or be subject to an ~9.5% interest rate      Recoupment period ends - repayment of outstanding balance due 

Hospitals repayment, recoupment and reconciliation timeline 
Updated Timeline
Time from date of payment receipt  Recoupment & Repayment
1 year  No payments due 
11 months  Medicare claims reduced by 25% 
6 months  Medicare claims reduced by 50% 
> 29 months provider may repay any balance due or be subject to a 4% interest rate  Recoupment period ends - repayment of outstanding balance due 

Non-hospitals repayment, recoupment and reconciliation timeline
Original Timeline 
Time from date of payment receipt  Recoupment & Repayment
120 days  No payments due 
121 - 210 days Medicare claims reduced by 100% 
> 210 days provider may repay any balance due or be subject to an ~9.5% interest rate Recoupment period ends - repayment of outstanding balance due 

Non-hospitals repayment, recoupment and reconciliation timeline
Updated Timeline 
Time from date of payment receipt  Recoupment & Repayment
1 year No payments due 
11 months  Medicare claims reduced by 25% 
6 months Medicare claims reduced by 50% 
> 29 months provider may repay any balance due or be subject to a 4% interest rate  Recoupment period ends - outstanding balance due 

Application:
Applications for accelerated payments can be found on each MACs' website. CMS has established COVID-19 hotlines at each MAC that are operational Monday through Friday to assist providers with accelerated or advance payment concerns. Access your designated MACs' website here.

The MAC will review the application to ensure the eligibility requirements are met. The provider/supplier will be notified of approval or denial by mail or email. If the request is approved, the MAC will issue the accelerated payment within seven calendar days from the request.

When funding is approved, the requested amount is compared to a database with amounts calculated by Medicare and provides funding at the lessor of the two amounts. The current form allows the provider to request the maximum payment amount as calculated by CMS or a lesser specified amount.

We are here to help
If you have questions or need more information about your specific situation, please contact the healthcare consulting team. We’re here to help.

Article
Medicare Accelerated Payment Program

Read this if you are an employer looking for more information on the Employee Retention Credit (ERC).

The Coronavirus Disease 2019 (COVID-19) stimulus package signed into law by President Trump on December 27 makes very favorable enhancements to the Employee Retention Credit (ERC) enacted under the Coronavirus Aid, Relief and Economic Security (CARES) Act. 

Background

The CARES Act passed in March 2020 provided certain employers with the opportunity to receive a refundable tax credit equal to 50 percent of the qualified wages (including allocable qualified health plan expenses) an eligible employer paid to its employees. This tax credit applied to qualified wages paid after March 12, 2020, and before January 1, 2021. The maximum amount of qualified wages (including allocable qualified health plan expenses) taken into account with respect to each eligible employee for all calendar quarters in 2020 is $10,000, so that the maximum credit an eligible employer can receive in 2020 on qualified wages paid to any eligible employee is $5,000.

The ERC was for eligible employers who carried on a trade or business during calendar year 2020, including certain tax-exempt organizations, that either:

  • Fully or partially suspend operation during any calendar quarter in 2020 due to orders from an appropriate governmental authority limiting commerce, travel, or group meetings due to COVID-19; or
  • Experienced a significant decline in gross receipts during the calendar quarter.

If an eligible employer averaged more than 100 full-time employees in 2019, qualified wages were limited to wages paid to an employee for time that the employee was not providing services due to an economic hardship described above. If the eligible employer averaged 100 or fewer full-time employees in 2019, qualified wages are the wages paid to any employee during any period of economic hardship described above.

Updated guidance: ERC changes

The bill makes the following changes to the ERC, which will apply from January 1 to June 30, 2021:

  • The credit rate increases from 50% to 70% of qualified wages and the limit on per-employee wages increases from $10,000 per year to $10,000 per quarter.
  • The gross receipts eligibility threshold for employers changes from a more than 50% decline to a more than 20% decline in gross receipts for the same calendar quarter in 2019. A safe harbor is provided, allowing employers that were not in existence during any quarter in 2019 to use prior quarter gross receipts to determine eligibility and the ERC. 
  • The 100-employee threshold for determining “qualified wages” based on all wages increases to 500 or fewer employees.
  • The credit is available to state or local run colleges, universities, organizations providing medical or hospital care, and certain organizations chartered by Congress (including organizations such as Fannie Mae, FDIC, Federal Home Loan Banks, and Federal Credit Unions). 
  • New, expansive provisions regarding advance payments of the ERC to small employers are included, including special rules for seasonal employers and employers that were not in existence in 2019. The bill also provides reconciliation rules and provides that excess advance payments of the credit during a calendar quarter will be subject to tax that is the amount of the excess.
  • Employers who received PPP loans may still qualify for the ERC with respect to wages that are not paid for with proceeds from a forgiven PPP loan. This change is retroactive to March 12, 2020. Treasury and the SBA will issue guidance providing that payroll costs paid during the PPP covered period can be treated as qualified wages to the extent that such wages were not paid from the proceeds of a forgiven PPP loan.
  • Removal of the limitation that qualified wages paid or incurred by an eligible employer with respect to an employee may not exceed the amount that employee would have been paid for working during the 30 days immediately preceding that period (which, for example, allows employers to take the ERC for bonuses paid to essential workers).

Takeaways

For most employers, the ERC has been difficult to use due to original requirements that prevented employers who received a PPP loan from ERC eligibility and, for those employers who did not receive a PPP loan, the requirement that there be a more than 50% decline in gross receipts. In addition, those employers who qualified for the ERC and had more than 100 employees could only receive the credit for wages paid to employees who did not perform services.

It is important to note that most of the new rules are prospective only and do not change the rules that applied in 2020. The new guidance should make it easier for more employers to utilize the ERC for the first two quarters of 2021. The following types of employers should evaluate the ability to receive the ERC during the first and/or second quarter of 2021:

  • Those that used the ERC in 2020 (the wage limit for the credit is now based on wages paid each quarter and the credit is 70% of eligible wages);
  • Those that previously received a PPP loan;
  • Those that have a more than 20% reduction in gross receipts in 2021 over the same calendar quarter in 2019;
  • Those employers with more than 100 but less than 500 employees who have had a significant reduction in gross receipts (i.e., more than 20%)1

For more information

If you have more questions, or have a specific question about your particular situation, please call us. We’re here to help.

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Stimulus bill extends and expands the Employee Retention Credit