Let’s Talk Compliance Recap: Provider Relief Fund Reporting Requirements & Compliance Concerns

In the latest installment of our “Let’s Talk Compliance” series, Foley & Lardner’s Alexis Bortniker and PYA’s Martie Ross answered numerous questions regarding Provider Relief Fund (PRF) reporting requirements. A recording of the event is available here.

Unfortunately, there were more questions from attendees than we could cover in 45 minutes, so as a supplement to the July 16 event, we have compiled those questions to offer the following responses.

What “official” resources are available to assist with reporting?

HHS’ Reporting Requirements and Auditing webpage includes links to the June 11, 2021, Post-Payment Notice of Reporting Requirements; relevant FAQs; recordings of the three webinars HHS presented in July 2021 addressing reporting requirements; the Portal Reporting User Guide; and the very helpful PRF Reporting Tutorial video. Also, you can contact call the Provider Support Line at (866) 569-3522 between 8 a.m. to 10 p.m. CT, Monday through Friday.

Do the expenses have to be entered as well as the lost revenue? Or can we just submit the lost revenue data?

HHS addressed this issue during its 7/20 webinar, stating one has the option of reporting no expenses for which PRF payments were used. Note, however, this may preclude the Reporting Entity from claiming COVID-related expenses incurred prior to 7/1/21 at a later date (e.g., report on subsequent PRF payments).

Is lost revenue based on gross revenue or net revenue? What payments should or should not be included in patient care revenues?

Based on our review of all available guidance, we believe the most defensible definition of “patient care revenue” for purposes of PRF reporting of lost revenue is the industry standard “net patient service revenue,” i.e., gross revenue less revenue deductions less implicit price concessions. To ensure a valid comparison between time periods (i.e., 2019, 2020, and Q1 and Q2 of 2021), HHS has instructed providers to subtract any revenue relating to patient services not furnished during the time period (e.g., supplemental payments, cost report settlements, A/R adjustments relating to prior years). (Note that no adjustment should be made to 2020/2021 patient care revenue to account for higher payment rates due to COVID-19 (e.g., suspension of Medicare sequestration, HRSA COVID-19 claims reimbursement for testing, treatment and vaccine administration for the uninsured); no patient care revenue—including these higher payment rates—should be included under “Other Assistance Received”). Any additional adjustments intended to “normalize” patient care revenue for purposes of comparing time periods would require one to use the third option for calculating lost revenue (alternate reasonable method).

We note the recent July 15 FAQ introduces some confusion regarding charges, payments, and contractual adjustments. The FAQ implies the definition of revenue is gross charges, which is not representative of available cash to cover expenses. We note this FAQ is inconsistent with references in HHS’ Reporting Portal User Guide, which uses the term “actual revenues/net charges received … for patient care” repeatedly. By using the word “received” rather than “billed,” HHS clearly indicates net revenue – not gross revenue – should be reported.

Do capitation payments count as patient care revenue?

We believe that entities should follow their historical basis of accounting (including revenue recognition policies) to account for capitation payments and other value-based care payments.

Are Medicare Advanced/Accelerated Payments received, but required to be repaid, included in “Other Assistance”?

Medicare Advance payments are NOT included in Other Assistance Received. The same is true for Paycheck Protection Program funds that have not been forgiven.

Option 3 for lost revenues only asks for losses in total, while options 1 and 2 ask for losses by payor. Is HHS expecting option 3 to also report by payor?

The portal requires input of a single number for lost revenue for a given quarter; there is no option to report by payor. HRSA has not placed any specific requirements on option 3, except to state it is the Reporting Entity’s burden to demonstrate reasonableness.

What constitutes obligated funds for FEMA? Is it when the applicant receives funds or when the grant is approved?

According to the FAQs, “[i]f a provider has submitted an application to FEMA, but has not yet received the FEMA funds, the provider should not report the requested FEMA amounts in the Provider Relief Fund report. If FEMA funds are received during the same Payment Received Period in which provider is reporting on use of Provider Relief Fund payments, the receipt and application of each payment type is required in the Provider Relief Fund reporting process. If an entity receives a retroactive payment from FEMA that overlaps with the period of availability, the entity must not use the FEMA payment on expenses or lost revenues already reimbursed by Provider Relief Fund payments.”

Our organization received funds 08/04/2020. Should we wait until after September 30, 2021, to report?

The organization must use these funds by December 31, 2021, and must report on the use of funds between January 1, 2022, and March 31, 2022. These funds cannot be included in the report relating to funds received by June 30, 2020.

What if our foundation raised money for “COVID”?

If the donations were specifically earmarked for COVID relief and cannot be used for any other purpose, they should be included as “Other.”

Is subsidiary defined by GAAP or tax return consolidated?

To determine whether an entity is the parent organization, the entity must follow the methodology used to determine a subsidiary in their financial statements. If none, the entity with a majority ownership (greater than 50%) will be considered the parent organization.

Please note, our PRF guidance is based on our best judgment of the available information in a rapidly changing and uncertain environment. The guidelines are rapidly evolving and should be checked frequently. As such, this blog is a snapshot in time. Foley & PYA are here to help you address the short- and long-term impacts in the wake of the guidance changes, and we have the resources to help you navigate these and other important legal considerations related to business operations and industry-specific issues. Please reach out either your Foley or PYA relationship partner with any questions.

You can listen to the program in its entirety, at no cost, by clicking here. Be sure to also check out the following Let’s Talk Compliance additional resources:

We are also excited to announce that we have our next Let’s Talk Compliance event, “The Telemedicine Cliff: Approaches for Navigating to the Other Side of the Public Health Emergency.” This event is scheduled for October 8^th, and you can register by clicking here.

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Foley & Lardner has been providing Health Care Law and business consultative services for more than 45 years. Our team of more than 150 attorneys regularly provides innovative, leading edge counsel to the entire spectrum of the healthcare industry. With offices throughout the United States, Foley’s Health Care Industry Team is consistently ranked as one of the top healthcare law firms nationally and regionally by Chambers USA and U.S. News. Foley remains at the forefront of health policy and law, advocating the interests of our health care clients in legislatures, administrative agencies, courts and boardrooms across the country.

PYA is a professional services firm with specialized expertise in healthcare consulting and certified public accounting. PYA’s multi-disciplinary Healthcare division serves hospitals, health systems, clinically integrated networks, physician groups, and specialty practices. Our healthcare services are structured around three main pillars: Strategy & Integration, Valuation (business, compensation, machinery and equipment, and litigation support), and Compliance. PYA consistently ranks as a Top 20 healthcare consulting firm and a Top 100 accounting firm in the U.S. Drawing upon the expansive depth of knowledge and breadth of experience of more than 300 professionals across offices in Atlanta, Kansas City, Knoxville, Nashville, and Tampa, and address the specific needs of a client base that spans 50 states.

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