Envision screwing doctors again!!!!

[Brigade4Radiant]

That was our last contract prior to dissolving our relationship with our CMG.

No ER doctor collects 1.2 - 1.4 m / year
We can bill whatever we want. We can bill $50K / chart. The average chart pays about $150.

Private equity wouldn’t thrive in ER if there wasn’t a hefty margins why do you think the books are closed and these ER groups often take the money losing hospitalist contract and can expand the way they do?

Also ER as a bell me field of medicine that’s hurting Rads and all the surgical subspecialies are dying.

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[dantt]

Anyone else notice that consult services are more likely to come into the ED now?

Ophtho here. We will have COVID patients come to ED to be seen rather than bring them into our own office. But more likely to go to the ED to see random patients? No way!!! Not worth it.

 

[thegenius]

Private equity wouldn’t thrive in ER if there wasn’t a hefty margins why do you think the books are closed and these ER groups often take the money losing hospitalist contract and can expand the way they do?

Also ER as a bell me field of medicine that’s hurting Rads and all the surgical subspecialies are dying.

Dude, i'm not gonna argue with you. I don't believe the numbers but there isn't much point arguing back and forth. There is no way an ER doctor brings home (e.g. collects) 1.2 - 1.4 m / year in any system ever in the history of mankind. Not legally that's for sure.

 

[EctopicFetus]

That was our last contract prior to dissolving our relationship with our CMG.

No ER doctor collects 1.2 - 1.4 m / year
We can bill whatever we want. We can bill $50K / chart. The average chart pays about $150.

I would be very careful in your assumptions.. some people work a lot.. yes the avg chart maybe pays $150. many CMGS collect more. I know of a few CMG and SDG sites collecting over $300 per patient.

I also know of a guy who made $180k in a month.. I also know of at least 3 ER MDs who made $1M in a year. Is it common.. NO WAY.. are there exceptions? yep.. yep there are.

 

[EctopicFetus]

Dude, i'm not gonna argue with you. I don't believe the numbers but there isn't much point arguing back and forth. There is no way an ER doctor brings home (e.g. collects) 1.2 - 1.4 m / year in any system ever in the history of mankind. Not legally that's for sure.

Ill say you are wrong.. as I said i know of a guy who made $180k in a month.. was a good month for him.. but others werent to far below.. said doctor works hard.. high volume moderate hours.. CMGS collect closer to $200.. USACS is the bottom of the toilet bowl with regards to collections and they are about $165.. Vituity is real ****ty too w/r/t their $/pt.

Still they also get subsidies etc.

 

[thegenius]

I would be very careful in your assumptions.. some people work a lot.. yes the avg chart maybe pays $150. many CMGS collect more. I know of a few CMG and SDG sites collecting over $300 per patient.

I also know of a guy who made $180k in a month.. I also know of at least 3 ER MDs who made $1M in a year. Is it common.. NO WAY.. are there exceptions? yep.. yep there are.

It’s still not 1.4M a year, and it’s not 1.2M a year and these are outliers...and we are talking in general terms here.

There are 55,000 ER physicians in the US. I would bet there are a handful, literally and that’s it, that regularly make more than 1M a year solely on collections.

Even if you picked the implausible scenario below you can’t get to 1.4M:

Work 12 months / year
Work 18 shifts / month
Work 12 hrs / shift
See 3 pts / hr
Make $150 / per patient

That only comes to $1.16M. Even if you did residency hours...and work 20 12 hr shifts / month it comes to 1.3M. But residents don’t even work that because they get vacation.

There are probably literally only a handful of people who could do this for 1 year and not get burned out.

So I don’t want to hear an argument about miracles....because it would a miracle for an ER doc to make 1.2-1.4M / year like it’s routine. It’s not even close to routine. It is just silly to say this stuff.

 

[thegenius]

It’s still not 1.4M a year, and it’s not 1.2M a year and these are outliers...and we are talking in general terms here.

There are 55,000 ER physicians in the US. I would bet there are a handful, literally and that’s it, that regularly make more than 1M a year solely on collections.

Even if you picked the implausible scenario below you can’t get to 1.4M:

Work 12 months / year
Work 18 shifts / month
Work 12 hrs / shift
See 3 pts / hr
Make $150 / per patient

That only comes to $1.16M. Even if you did residency hours...and work 20 12 hr shifts / month it comes to 1.3M. But residents don’t even work that because they get vacation.

There are probably literally only a handful of people who could do this for 1 year and not get burned out.

So I don’t want to hear an argument about miracles....because it would a miracle for an ER doc to make 1.2-1.4M / year like it’s routine. It’s not even close to routine. It is just silly to say this stuff.

Oh and the doc above would die in a car accident driving home because he fell asleep. So what good is that person then

 

[thegenius]

We are not counting one-off good months, where someone can make $180K we are discussing this general concept that ER docs make 20% or so of collections and even most CMGs, despite them being douche-bag c-suckers don’t take that much out.

 

[EctopicFetus]

It’s still not 1.4M a year, and it’s not 1.2M a year and these are outliers...and we are talking in general terms here.

There are 55,000 ER physicians in the US. I would bet there are a handful, literally and that’s it, that regularly make more than 1M a year solely on collections.

Even if you picked the implausible scenario below you can’t get to 1.4M:

Work 12 months / year
Work 18 shifts / month
Work 12 hrs / shift
See 3 pts / hr
Make $150 / per patient

That only comes to $1.16M. Even if you did residency hours...and work 20 12 hr shifts / month it comes to 1.3M. But residents don’t even work that because they get vacation.

There are probably literally only a handful of people who could do this for 1 year and not get burned out.

So I don’t want to hear an argument about miracles....because it would a miracle for an ER doc to make 1.2-1.4M / year like it’s routine. It’s not even close to routine. It is just silly to say this stuff.

You are stuck on the $150/pt. plenty of sites make $200+. a few at $300 (though maybe not for long).

Lowest I ever heard was a site in SC at $80/pt.

A few things to consider on the business side.. $250/pt or up to $330-350/pt at the top places I know.

Now throw in money from MLPs. you can see how that would work. Lets say you see 300 patients a month at whatever hours you might need. thats 90k a month in collections. Many people see more than that. NOw throw in some MLP action running your FT. lets assume the payer mix there is worse. Lets say way worse.. at $200/pt.. they make you $00/hr while you pay including benefits $100/hr.. thats another $300/hr in profit.. divide it by 4? Thats another $75/hr that you work.. could easily add in 10k a month from their labor.. thats 120k a year..

These arent extreme numbers except the $/pt. USACS is at about $165/pt across the nation.. their contracts are semi crappy. Envision has some great contracts.. Dont believe me ask your friends who see an EM doc there. I have.. I have the EOBs to prove it. Envisions contracted rate with some major payers is well over 400% of medicare.

 

[EctopicFetus]

We are not counting one-off good months, where someone can make $180K we are discussing this general concept that ER docs make 20% or so of collections and even most CMGs, despite them being douche-bag c-suckers don’t take that much out.

Indeed they do.. 20% would be not terrible and fairly lean. 30% would be cheap.

Even in your example of 150/pt and them seeing 2pph that's $300/hr in revenue.. oh and that rich ass MLP money they make. AGain the crappiest CMG is USACS and they are around $165/pt.

 

[Brigade4Radiant]

Dude, i'm not gonna argue with you. I don't believe the numbers but there isn't much point arguing back and forth. There is no way an ER doctor brings home (e.g. collects) 1.2 - 1.4 m / year in any system ever in the history of mankind. Not legally that's for sure.

Dude if you don’t wanna believe it that’s fine but just because you’re closing your eyes to what’s on the box doesn’t make it true. The Becker hospital report says otherwise and lists what revenues other physicians make. ER groups take the hospitalist losing contracts to get the ER contract for a reason not for the kindness of our hearts but because it’s highly probable.

Books are closed for a reason. 150 per patient is in a poor payer mix. 300-500 per chart in a well paying payer mix.

 

[EctopicFetus]

Dude if you don’t wanna believe it that’s fine but just because you’re closing your eyes to what’s on the box doesn’t make it true. The Becker hospital report says otherwise and lists what revenues other physicians make. ER groups take the hospitalist losing contracts to get the ER contract for a reason not for the kindness of our hearts but because it’s highly probable.

Books are closed for a reason. 150 per patient is in a poor payer mix. 300-500 per chart in a well paying payer mix.

Agreed. Highest I have confirmed is in the mid 300s but there could be FSEDs or other smaller EDs working in very wealthy parts of town that can push that up. Also people have to consider the MLP portion of income. CMGs need MD/DOs to provide oversight. Outside of a small cut in medicare other payers for the most part pay the same as if a doc saw the patient.

150/pt is fairly crappy.. agreed.

 

[Birdstrike]

Dude if you don’t wanna believe it that’s fine but just because you’re closing your eyes to what’s on the box doesn’t make it true. The Becker hospital report says otherwise and lists what revenues other physicians make. ER groups take the hospitalist losing contracts to get the ER contract for a reason not for the kindness of our hearts but because it’s highly probable.

Books are closed for a reason. 150 per patient is in a poor payer mix. 300-500 per chart in a well paying payer mix.

Somebody go look in MGMA. All these numbers (overhead, collections, salary) are in MGMA.

 

[EctopicFetus]

Somebody go look in MGMA. All these numbers (overhead, collections, salary) are in MGMA.

Lets be real.. MGMA data isn't terribly accurate. I don't have access to it but would be curious. If envision is collecting 600+ from commercial insurance and avg medicare is $168.. Medicaid pays about 70-80% of medicare (though with a lower acuity). that leaves self pay which is roughly $24/pt. input those numbers into your payer mix and you can guess the $/pt.

Dont forget the real profit center.. the MLPs. Private equity isn't going into EM because there isn't money to be made.

 

[Birdstrike]

Lets be real.. MGMA data isn't terribly accurate.

MGMA isn't 100% accurate, but with all due respect, if I have to put my money on MGMA vs "two dudes fighting about stuff on the internet" I'm putting my $5 on MGMA. I might lose, but...

 

[Birdstrike]

Lets be real.. MGMA data isn't terribly accurate. I don't have access to it but would be curious. If envision is collecting 600+ from commercial insurance and avg medicare is $168.. Medicaid pays about 70-80% of medicare (though with a lower acuity). that leaves self pay which is roughly $24/pt. input those numbers into your payer mix and you can guess the $/pt.

Dont forget the real profit center.. the MLPs. Private equity isn't going into EM because there isn't money to be made.

...That being said, every doc should have a good idea of what their company is collecting as a product of their work and how much is actually coming to them. I can tell you to the dollar, how much my group collects in my name, how much is paid out to me, and what percentage that is in relation to my overhead. My take home tends to be about 50% of my collections, but as an outpatient guy with higher overhead than when I was in EM, you can't compare EM to what I do now. Certainly your take home pay should be much greater than 50% of your collections in EM, since an ER doc's overhead is much lower than an outpatient doc paying salaries and rent. Whether it is, and whether one even knows or not, is another story. It's hard when you're in EM though. You have much less knowledge and control over this kind of stuff in EM and the managers like it that way.

 

[GeneralVeers]

This is precisely why ACEP should mandate that all companies employing physicians release a yearly total of how much they have billed, and collected in that physician's name, including an hour rate. It would be eye-opening for most doctors to see the theft of THEIR money.

 

[RustedFox]

This is precisely why ACEP should mandate that all companies employing physicians release a yearly total of how much they have billed, and collected in that physician's name, including an hour rate. It would be eye-opening for most doctors to see the theft of THEIR money.

Unfortunately, its ACEP.
Maybe we can get AAEM to do just that.

#physicianrevolution

 

[beekle]

...That being said, every doc should have a good idea of what their company is collecting as a product of their work and how much is actually coming to them. I can tell you to the dollar, how much my group collects in my name, how much is paid out to me, and what percentage that is in relation to my overhead. My take home tends to be about 50% of my collections, but as an outpatient guy with higher overhead than when I was in EM, you can't compare EM to what I do now. Certainly your take home pay should be much greater than 50% of your collections in EM, since an ER doc's overhead is much lower than an outpatient doc paying salaries and rent. Whether it is, and whether one even knows or not, is another story. It's hard when you're in EM though. You have much less knowledge and control over this kind of stuff in EM and the managers like it that way.

What do you think is a fair takehome as a percentage of collections? I can't help but feel this would not be an accurate (or fair) way of determining your salary in any case- if it was you'd see much higher salaries in posh zip codes, with better payor mixes and higher reimbursements. That may be the case for procedural specialties but I wouldn't want our specialty to go in that direction.

 

[RustedFox]

What do you think is a fair takehome as a percentage of collections? I can't help but feel this would not be an accurate (or fair) way of determining your salary in any case- if it was you'd see much higher salaries in posh zip codes, with better payor mixes and higher reimbursements. That may be the case for procedural specialties but I wouldn't want our specialty to go in that direction.

The only correct answer is:

"Whatever is left over after minimizing all other necessary expenses; administrative, technical, legal, and coding/billing."

Right now, instead - its;

"Whatever is left over after the admins and non-clinical staff maximize their salaries, bloat, and benefits."

 

[GeneralVeers]

The only correct answer is:

"Whatever is left over after minimizing all other necessary expenses; administrative, technical, legal, and coding/billing."

Right now, instead - its;

"Whatever is left over after the admins and non-clinical staff maximize their salaries, bloat, and benefits."

You are advocating for an SDG. The problem is that people like Dbag start up an SDG, then think "Hey, I can employ other doctors at other sites and take a small percentage". Pretty soon people like Dbag have expanded, and are sitting back collecting fees from all their minion doctors in multiple contracts. That's how USACS started.

 

[Birdstrike]

What do you think is a fair takehome as a percentage of collections? I can't help but feel this would not be an accurate (or fair) way of determining your salary in any case- if it was you'd see much higher salaries in posh zip codes, with better payor mixes and higher reimbursements. That may be the case for procedural specialties but I wouldn't want our specialty to go in that direction.

There is no way to pay Emergency Physicians other than from the money brought in by their work, minus the expenses generated by those physicians. There are plenty of ways to trick you into thinking you're paid by some other formula, but in reality, there is none.

 

[RustedFox]

You are advocating for an SDG. The problem is that people like Dbag start up an SDG, then think "Hey, I can employ other doctors at other sites and take a small percentage". Pretty soon people like Dbag have expanded, and are sitting back collecting fees from all their minion doctors in multiple contracts. That's how USACS started.

You're right; and you also illustrate (very well) an earlier post of mine that states that its the irresponsibles in the system to allow mistakes to flourish.
In your example, its no longer a SDG once D-bag gets involved.

 

[TooMuchResearch]

Our group voted maybe 1.5 years ago to back out of an RFP we had put quite a bit of effort into and decided not to pursue new contracts unless really good offers just fall in our lap. We feel like we're on the bigger end of what we're comfortable with and don't want to accidentally become something other than a democratic group.

You are advocating for an SDG. The problem is that people like Dbag start up an SDG, then think "Hey, I can employ other doctors at other sites and take a small percentage". Pretty soon people like Dbag have expanded, and are sitting back collecting fees from all their minion doctors in multiple contracts. That's how USACS started.

 

[EctopicFetus]

MGMA isn't 100% accurate, but with all due respect, if I have to put my money on MGMA vs "two dudes fighting about stuff on the internet" I'm putting my $5 on MGMA. I might lose, but...

Appreciate that... but the MGMA data for EM is woeful. Also I have never seen anything remotely close to what you suggest for EM.

 

[EctopicFetus]

What do you think is a fair takehome as a percentage of collections? I can't help but feel this would not be an accurate (or fair) way of determining your salary in any case- if it was you'd see much higher salaries in posh zip codes, with better payor mixes and higher reimbursements. That may be the case for procedural specialties but I wouldn't want our specialty to go in that direction.

LOl.. you dont think this already happens?

 

[EctopicFetus]

The only correct answer is:

"Whatever is left over after minimizing all other necessary expenses; administrative, technical, legal, and coding/billing."

Right now, instead - its;

"Whatever is left over after the admins and non-clinical staff maximize their salaries, bloat, and benefits."

Right now it is whatever the minimum market will bear. has nothing to do with the other stuff. Plenty of room to fill up profits and pursue other contracts.

 

[EctopicFetus]

Our group voted maybe 1.5 years ago to back out of an RFP we had put quite a bit of effort into and decided not to pursue new contracts unless really good offers just fall in our lap. We feel like we're on the bigger end of what we're comfortable with and don't want to accidentally become something other than a democratic group.

Same.. we decided only to be strategic in our growth. We have been approached and have thus far abcked out. I think the smarter move and better move is to take the contract and have a 5 year plan to get out. Take a sum of money for the effort and risk to get it started. Then hand the keys to someone else.

 

[Birdstrike]

Appreciate that... but the MGMA data for EM is woeful. Also I have never seen anything remotely close to what you suggest for EM.

If the money to pay you doesn’t come from the work you do, where are you guys getting the money to pay yourselves?

You have some other revenue stream that comes from something other than the work the doctors do?

 

[turkeyjerky]

Medical Staffing Companies Owned by Rich Investors Cut Doctor Pay and Now Want Bailout Money — ProPublica

 

[TooMuchResearch]

We have a scribe business that extends beyond our group (multiple specialty and primary care clinics). Obviously not a huge revenue stream relative to our clinical work. And not a revenue stream at all right now.

If the money to pay you doesn’t come from the work you do, where are you guys getting the money to pay yourselves?

You have some other revenue stream that comes from something other than the work the doctors do?

 

[Birdstrike]

We have a scribe business that extends beyond our group (multiple specialty and primary care clinics). Obviously not a huge revenue stream relative to our clinical work. And not a revenue stream at all right now.

In other words, that scribe business is a very small percentage of your group's revenue, that only exists because of the work of providers. It's an exception that proves the rule. (My group also has an in-house lab and a billing department, but again, that only exists as a product of the work of the providers, and exists more as a convenience than a revenue stream).

Any of you that think you're not paid out of money that comes from collections, from the work you do, tell your group, "I'm not going to work for the next six months, but you can keep paying me out of passive income from me being on staff, due to my medical degree and residency certificate." A person who owns a lot of paid of rental properties can do that. Physician can't.

You're paid from money you bring in via collections, either as an individual or as a group.

 

[KeikoTanaka]

Looks like 1/3 pay cut? Ouch. Im wondering when the cuts are gonna start happening here. Volumes are so low in the ED. ( which just goes to show how much BS comes into the ED), I wouldnt be surprised to see most docs getting pay cuts coming up. What I am more worried about, are the damn customer satisfaction scores. That nonsense is prob gonna be even more important to admin because they want their ERs full. Since volumes are down, I can see them using pt satisfaction metrics more than ever. God help us.

Honestly, I know that a lot of BS comes through the ED, but also think about how much the pandemic has cut down on everyone's overall activity. I'd be willing to bet even criminals are nervous about going out because at the end of the day they know they can get severely sick. That 56 year old who is normally on the brink of an MI is not stressing himself out at work so he doesn't develop it, all other communicable diseases and STDs probably have dropped because everyone all in all is just not going out. Diabetics probably aren't putting themselves into hyperosmolar hyperglycemic syndrome cuz they have to ration their foods.... That usual weekend warrior with the ankle sprain isn't going out because their 5k was cancelled... I'm sure there is a lot of reasons people aren't getting ~as sick~

 

[Apollyon]

Honestly, I know that a lot of BS comes through the ED, but also think about how much the pandemic has cut down on everyone's overall activity. I'd be willing to bet even criminals are nervous about going out because at the end of the day they know they can get severely sick. That 56 year old who is normally on the brink of an MI is not stressing himself out at work so he doesn't develop it, all other communicable diseases and STDs probably have dropped because everyone all in all is just not going out. Diabetics probably aren't putting themselves into hyperosmolar hyperglycemic syndrome cuz they have to ration their foods.... That usual weekend warrior with the ankle sprain isn't going out because their 5k was cancelled... I'm sure there is a lot of reasons people aren't getting ~as sick~

In my area, OD deaths are up. I don't know how much, bit the public health folks have announced it.

 

[KeikoTanaka]

In my area, OD deaths are up. I don't know how much, bit the public health folks have announced it.

My friend who works as a counselor in an inner city school district and therefore knows some **** that goes on in these broken families reported to me that sexual abuse from fathers against their kids is up tremendously since the quarantine too. Obviously not something that would go to the ED, but a sad / disgusting thing to learn.

 

[TooMuchResearch]

Oh yeah, it's a tiny portion of total revenue. We have no other fruit bearing trees as a group.

In other words, that scribe business is a very small percentage of your group's revenue, that only exists because of the work of providers. It's an exception that proves the rule. (My group also has an in-house lab and a billing department, but again, that only exists as a product of the work of the providers, and exists more as a convenience than a revenue stream).

Any of you that think you're not paid out of money that comes from collections, from the work you do, tell your group, "I'm not going to work for the next six months, but you can keep paying me out of passive income from me being on staff, due to my medical degree and residency certificate." A person who owns a lot of paid of rental properties can do that. Physician can't.

You're paid from money you bring in via collections, either as an individual or as a group.

 

[EctopicFetus]

If the money to pay you doesn’t come from the work you do, where are you guys getting the money to pay yourselves?

You have some other revenue stream that comes from something other than the work the doctors do?

What I am saying is I have never seen MGMA data that spells out the items you listed.

My group is open books. Also keep in mind MLP profit can be substantial. CMGs use a ton of them.

 

[Dr Mantis Toboggan]

we got our Medicare CARES bonus yesterday. Not huge but every little bit helps right now.

What I am saying is I have never seen MGMA data that spells out the items you listed.

My group is open books. Also keep in mind MLP profit can be substantial. CMGs use a ton of them.

 

[Birdstrike]

What I am saying is I have never seen MGMA data that spells out the items you listed.

My group is open books. Also keep in mind MLP profit can be substantial. CMGs use a ton of them.

Check your DMs

 

[EctopicFetus]

we got our Medicare CARES bonus yesterday. Not huge but every little bit helps right now.

It’s like $7500 or so per doc.. that was also the number someone posted on the other site.

 

[RustedFox]

Pictures Say Thousands of Words - Authentic Medicine

Above are two advertisements. We understand that the second one is NJ and the first is NY but here is

authenticmedicine.com

 

[thegenius]

Pictures Say Thousands of Words - Authentic Medicine

Above are two advertisements. We understand that the second one is NJ and the first is NY but here is

authenticmedicine.com

f'ing terrible

 

[thegenius]

we got our Medicare CARES bonus yesterday. Not huge but every little bit helps right now.

does every ER doctor get that?

 

[Birdstrike]

we got our Medicare CARES bonus yesterday. Not huge but every little bit helps right now.

What the hell is a "Medicare CARES bonus"? Is that the 1% sequester cash they're supposed to be giving us through 12/31/20 or something else?

 

[Birdstrike]

Pictures Say Thousands of Words - Authentic Medicine

Above are two advertisements. We understand that the second one is NJ and the first is NY but here is

authenticmedicine.com

I this a joke?

 

[bravotwozero]

What the hell is a "Medicare CARES bonus"? Is that the 1% sequester cash they're supposed to be giving us through 12/31/20 or something else?

My understanding was that it is to go to doctors practices so they can maintain payroll...Perhaps you should look into it if you need it to pay your docs/staff.

 

[beekle]

LOl.. you dont think this already happens?

Are you saying we get paid more to work in desirable areas? Or that CMGs use hospitals in good payor mix areas to keep their margins high? I think it's the second - if anything it seems the more desirable the area ( usually indicating a better the payor mix, though not always ) the LESS you get paid.

 

[Birdstrike]

My understanding was that it is to go to doctors practices so they can maintain payroll...Perhaps you should look into it if you need it to pay your docs/staff.

Our CFO and COO have lawyers going through that law with a fine tooth comb to find every penny available to us, I just wondered if @Dr Mantis Toboggan knew specifically what part of the law is was from.

 

[Dr Mantis Toboggan]

Our CFO and COO have lawyers going through that law with a fine tooth comb to find every penny available to us, I just wondered if @Dr Mantis Toboggan knew specifically what part of the law is was from.

I think it’s 6.2% of your annual Medicare billing that drops as a bonus, not a loan. We are in network with every insurer so don’t have to worry about the balance billing part. We did not apply for that it just dropped into the account. I’m sure Envision will pass along a rightful share to all its docs...


CARES Act Provider Relief Fund
President Trump is providing support to healthcare providers fighting the COVID-19 pandemic. On March 27, 2020, the President signed the bipartisan CARES Act that provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19.
Immediate infusion of $30 billion into healthcare system
Recognizing the importance of delivering funds in a fast and transparent manner, $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American healthcare system. These are payments, not loans, to healthcare providers, and will not need to be repaid.
Who is eligible for initial $30 billion

• All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.
• Payments to practices that are part of larger medical groups will be sent to the group's central billing office.
  • All relief payments are made to the billing organization according to its Taxpayer Identification Number (TIN).
• As a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
• This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services.
• If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

How are payment distributions determined

• 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.
• A provider 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. Providers can obtain their 2019 Medicare FFS billings from their organization's revenue management system.
• As an example: A community hospital billed Medicare FFS $121 million in 2019. To determine how much they would receive, use this equation:
  • $121,000,000/$484,000,000,000 x $30,000,000,000 = $7,500,000

What to do if you are an eligible provider

• HHS has partnered with UnitedHealth Group (UHG) to provide rapid payment to providers eligible for the distribution of the initial $30 billion in funds.
• Providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS).
  • The automatic payments will come to providers via Optum Bank with "HHSPAYMENT" as the payment description.
  • Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well, within the next few weeks.
• Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020, and will be linked on this page.
• HHS' payment of this initial tranche of funds is conditioned on the healthcare provider's acceptance of the Terms and Conditions - PDF, which acceptance must occur within 30 days of receipt of payment. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions. If a provider receives payment and does not wish to comply with these Terms and Conditions, the provider must do the following: contact HHS within 30 days of receipt of payment and then remit the full payment to HHS as instructed. Appropriate contact information will be provided soon.

Is this different than the CMS Accelerated and Advance Payment Program?
Yes. The CMS Accelerated and Advance Payment Program has delivered billions of dollars to healthcare providers to help ensure providers and suppliers have the resources needed to combat the pandemic. The CMS accelerated and advance payments are a loan that providers must pay back. Read more information from CMS.

 

[Birdstrike]

I think it’s 6.2% of your annual Medicare billing that drops as a bonus, not a loan. We are in network with every insurer so don’t have to worry about the balance billing part. We did not apply for that it just dropped into the account. I’m sure Envision will pass along a rightful share to all its docs...


CARES Act Provider Relief Fund
President Trump is providing support to healthcare providers fighting the COVID-19 pandemic. On March 27, 2020, the President signed the bipartisan CARES Act that provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19.
Immediate infusion of $30 billion into healthcare system
Recognizing the importance of delivering funds in a fast and transparent manner, $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American healthcare system. These are payments, not loans, to healthcare providers, and will not need to be repaid.
Who is eligible for initial $30 billion

• All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.
• Payments to practices that are part of larger medical groups will be sent to the group's central billing office.
  • All relief payments are made to the billing organization according to its Taxpayer Identification Number (TIN).
• As a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
• This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services.
• If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

How are payment distributions determined

• 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.
• A provider 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. Providers can obtain their 2019 Medicare FFS billings from their organization's revenue management system.
• As an example: A community hospital billed Medicare FFS $121 million in 2019. To determine how much they would receive, use this equation:
  • $121,000,000/$484,000,000,000 x $30,000,000,000 = $7,500,000

What to do if you are an eligible provider

• HHS has partnered with UnitedHealth Group (UHG) to provide rapid payment to providers eligible for the distribution of the initial $30 billion in funds.
• Providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS).
  • The automatic payments will come to providers via Optum Bank with "HHSPAYMENT" as the payment description.
  • Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well, within the next few weeks.
• Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020, and will be linked on this page.
• HHS' payment of this initial tranche of funds is conditioned on the healthcare provider's acceptance of the Terms and Conditions - PDF, which acceptance must occur within 30 days of receipt of payment. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions. If a provider receives payment and does not wish to comply with these Terms and Conditions, the provider must do the following: contact HHS within 30 days of receipt of payment and then remit the full payment to HHS as instructed. Appropriate contact information will be provided soon.

Is this different than the CMS Accelerated and Advance Payment Program?
Yes. The CMS Accelerated and Advance Payment Program has delivered billions of dollars to healthcare providers to help ensure providers and suppliers have the resources needed to combat the pandemic. The CMS accelerated and advance payments are a loan that providers must pay back. Read more information from CMS.

Thank you.