Accelerated Payments

The 42 Code of Federal Regulations (CFR), Section 413.64(g), includes a provision for financial relief to Medicare health care providers. Accelerated payments are available to providers experiencing financial difficulties due to abnormal payment delays. On rare occasions, providers incurring abnormal delays in submitting their claims due to circumstances beyond their control (e.g., flood, fire, etc.) may also be eligible.

An abnormal delay in payment refers to claims processed more than 30 days from the date received by the intermediary.

Medical review is considered to be a normal part of our claims process. Therefore, claims being reviewed do not typically qualify for an accelerated payment. Claims current within the normal processing cycle time frames (within 30 days) may not be considered in the calculation for the accelerated payment.

Accelerated payments do not replace normal payments. Accelerated payments are an advance against future payments to help with your facility's cash flow. It cannot exceed 70 percent of normal reimbursement. The information needed to request an accelerated payment is summarized in the following list. Chapter 24, § 2412 of Part I of the Provider Reimbursement Manual (CMS Pub. 15-1) discusses accelerated procedures.

1. Submit your most recent balance sheet and income statement
2. Submit a signed accelerated payment certification request (see a copy later in this section). A signature is needed for both statements on the certification form. The Administrator or Chief Financial Officer must sign the certification.
3. Submit a cover letter detailing the problem and requesting the accelerated payment.
4. Provide aging list or summary of claims not paid. The list of affected claims should include the following data: patient name; service dates; number of visits; and the Health Insurance Claim Number (HICN).
5. Claims must be in the intermediary system 30 days. A limited number of circumstances exist when an accelerated payment may be issued for unbilled claims. In this case, you should explain the delay.

An official of your agency must certify the validity of a request for accelerated payment by signing the Accelerated Payment Request Certification form. The provider representative signing the form must be at least at the level of Chief Financial Officer. The certifications will hold your agency, and the official of your agency who signs the certification, accountable for any misrepresentations made to the Centers for Medicare & Medicaid Services (CMS) in the course of obtaining an accelerated payment.

All accelerated payment requests are reviewed to ensure that all conditions in §2412.1 are met. If all conditions are met, we forward a recommendation to our CMS regional office. The CMS regional office notifies us with a fax when the accelerated payment is approved. We will call you once a decision is made on your request. This review process takes approximately three or four working days to complete.

Approval creates an expectation that the accelerated payment will be fully recovered within 90 days of issuance.  If there is an outstanding balance after 90 days, the balance is considered an overpayment. Interest will be charged on the overpayment balance in accordance to 42 CFR §405.378.

 Page last updated: June 3, 2008

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