Request for Advance Payment Instruction

Palmetto GBA and the Centers for Medicare & Medicaid Services (CMS) will consider, in limited circumstances, an advance payment for Part B providers that are experiencing financial hardship due to claims that are unable to process within established time limits.

This applies to claims that have been submitted, but payment has not been made due to a system malfunction. This does not apply to claims that have not paid due to claims submission errors.

An advance payment may be made if all of the following conditions are met:

• The Medicare Administrative Contractor (MAC) is unable to process the provider’s or supplier’s claims timely
• CMS determines that the prompt payment interest provision specified in Section 1842(c) under title XVIII of the Social Security Act is insufficient to make a claimant whole
• CMS authorizes the MAC to make an advance payment to the provider or supplier

An advance payment cannot be made if any of the following conditions apply:

• The provider is delinquent in repaying a Medicare overpayment
• The provider is under active medical review or program integrity investigation
• The provider has not submitted any claims
• Claim assignment has not been accepted within the most recent 180-day period preceding the system malfunction
• The provider is in bankruptcy

If you are a Jurisdiction M provider and you meet all required conditions outlined above and would like to request an advance payment, you must submit a Request for Accelerated/Advance Payment (PDF) form to JM.FinancialRelief@PalmettoGBA.com.

These forms are available under the Finance/Overpayments section in the Forms tool. The request must be signed by an authorized person, state the reason your cash balance is seriously impaired, and include information to show hardship.

Upon receipt of the request, Palmetto GBA then determines if the provider qualifies for an advance payment. If all qualifications are met, the amount of the advance payment is calculated, and the request is forwarded to CMS for approval. The advance payment is calculated using historical claims data and the payment is no more than 80% of the anticipated payment for the claims. If historical data cannot be utilized, or backlogged claims cannot be identified, some other methodology will be approved by CMS.

If approved, you agree that Palmetto GBA will recover the advance payment by applying the amount due to future payments. Recovery of an advance payment is made within 90 days after it is issued. Should there not be enough collections within those 90 days, the remaining amount will be demanded and considered an overpayment.

To extent that a delay in the provider’s billing process is the basis for the advance payment, recoupment is made by a 100 percent withhold against the provider’s bills processed or other monies due to the provider after the date of issuance of the advance payment.

The decision to approve an advance payment and the amount of the payment is at CMS' discretion and are not subject to review or appeal.

Please note that CMS expects these requests to be limited. In most cases, corrections can be made and claims finalized before an advance payment request can be processed.