PROVIDER RELIEF FUND UPDATE

APPLICATION DEADLINE IS EXTENDED FROM AUGUST 3 TO AUGUST 28

Published July 23, 2020
Updated August 3, 2020

The headline says it all. You don’t need to scramble to complete your application (or sort out some mix-up with your application) by the end of today.

 

One question that’s been on many dentists’ minds is whether they can balance bill patients after they receive the HHS grant.  If they can’t, then this HHS program won’t be very helpful.

 

The Terms and Conditions that the recipient will have to attest to include a provision that, “The Secretary has concluded that the COVID-19 public health emergency has caused many healthcare providers to have capacity constraints. As a result, patients that would ordinarily be able to choose to receive all care from in-network healthcare providers may no longer be able to receive such care in-network. Accordingly, for all care for a presumptive or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient.”

 

Many dentists have been getting what we think is improper advice on this.  That advice stems from the distinction between the words, “possible” and “presumptive.”  HHS considers any patient a “possible” case of Covid-19 for purposes of spending the HHS grant in an acceptable manner (which is a good thing for dentists because it allows them to spend this money in broad ways).

 

But, not every patient is a “presumptive” case of Covid-19, and this balance billing concept only applies to presumptive and actual cases, not possible cases.  Therefore, if you receive the grant and do not treat any actual or presumed Covid patients (which is likely since you’ll be sending all these people home), then you can truthfully attest to this provision that you didn’t balance bill such patients.

 

In fact, our interpretation was recently supported by the following FAQ that came out yesterday, “Balance Billing – QUESTION - The Terms and Conditions require recipients to attest that for all care for a presumptive or actual case of COVID-19 the recipient will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network recipient. How should dental providers comply with this requirement? (Added 7/22/2020)

 

ANSWER - The prohibition on balance billing applies to “all care for a presumptive or actual case of COVID-19.” A presumptive case of COVID-19 is a case where a patient’s medical record documentation supports a diagnosis of COVID-19, even if the patient does not have a positive in vitro diagnostic test result in his or her medical record. Dental providers who are not caring for patients with presumptive or actual cases of COVID-19 would not be subject to this provision.”

 

Lastly, the fact that these grants are subject to possible audit would not discourage us.  For most dental practices, the grants will be relatively modest (compared to large hospital systems) and the government agencies likely won’t have the time or resources to devote to auditing them.

 

Ultimately, the decision to apply for this is a function of your risk tolerance for satisfying the terms and conditions and of an audit.  We think these risks are modest and that dentists should be able to meet the terms and conditions.  If you can accept that your grant will be a matter of public record, then we recommend applying for it.

Collier & Associates, Inc. will update our blog as the CARES Act progresses. We take pride in continuing to keep our subscribers and website visitors updated on current events during this extraordinary time.

We will work diligently to answer general inquiries via our website if time permits and in a little more detail within our Newsletters. However, if your questions are detailed in nature, please request to set up a conference call for a formal legal consultation. Thank you.

DISCLOSURE

Collier & Associates, Inc. provides this information as a service to clients and other friends for educational purposes only. It should not be construed or relied on as legal advice or to create a lawyer-client relationship. Readers should not act on this information without seeking advice from professional advisors.

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(216) 765-1199

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