As Medicare Advance and Accelerated Payments (AAP) repayment begin soon, facilities should make note of the applicable terms. Information on establishing an extended repayment schedules (ERS) is included in the Medicare Financial Management manual.

Repayments will begin for all Medicare providers, including skilled nursing facilities, one year from the date of receipt. Repayment terms include:  

• Repayment begins one year from the date the accelerated or advance payment was issued.  
• Beginning one year from the date the payment was issued and continuing for eleven months, Medicare payments owed to providers and suppliers will be recouped at a rate of 25 percent. 
• After the eleven months, Medicare payments owed to providers and suppliers will be recouped at a rate of 50 percent for another six months.   
  

Ability to Submit ERS Applications 

After the six months (29 months from the initial AAP), MACs will issue letters for the remaining balance of the accelerated or advance payment(s). If a letter requiring reimbursement is issued, providers and suppliers will have 30 days from the date of the letter to repay the balance in full. If payment is not received within 30 days, interest will accrue at the rate of four percent from the date the letter was issued and will be assessed for each full 30-day period that the balance remains unpaid.

Information related to Extended Repayment Schedules (ERS) will be included in these letters. For information on establishing an ERS, scroll down to section 50 (page 45) of the Medicare Financial Management manual. Providers and suppliers will only be able to request ERSs after the 30-day demand letters are issued. 

Additional Information

Based on the statutorily defined schedule, SNFs should assess their cash flow for the second quarter of 2021. AHCA/NCAL has put together an overview of the repayment schedule, additional AAP information (including options to request payment extensions), and MAC webpages. You may also review the CMS AAP Repayment and Recovery FAQs here.