MODIFIED 3/31/2021
Healthcare related expenses attributable to coronavirus may include items such as supplies, equipment, information technology, facilities, employees, and other healthcare related costs/expenses for the calendar year. The classification of items into categories should align with how Provider Relief Fund recipients maintain their records. Providers can identify their healthcare related expenses, and then apply any amounts received through other sources, such as direct patient billing, commercial insurance, Medicare/Medicaid/Children’s Health Insurance Program (CHIP), or other funds received from the Federal Emergency Management Agency (FEMA), the Provider Relief Fund COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured, and the Small Business Administration (SBA) and Department of Treasury’s Paycheck Protection Program (PPP) that offset the healthcare related expenses. Provider Relief Fund payments may be applied to the remaining expenses or costs, after netting the other funds received or obligated to be received which offset those expenses. The Provider Relief Fund permits reimbursement of marginal increased expenses related to coronavirus provided those expenses have not been reimbursed from other sources or that other sources are not obligated to reimburse.
For example, assume the following: A $5 increase in expense or cost to provide an office visit is calculated by pre-pandemic cost vs. post-pandemic cost, regardless of reimbursement source:
• Pre-pandemic average expense or cost to provide an office visit = $80
• Post-pandemic average expense or cost to provide an office visit = $85
Examples of reimbursed amounts may include, but not be limited to:
• Example 1 Medicaid reimbursement: $70 (Report $85-$80 = $5 as expense attributable to
coronavirus but unreimbursed by other sources)
• Example 2 Medicare reimbursement: $80 (Report $85-$80 = $5 as expense attributable to
coronavirus but unreimbursed by other sources)
• Example 3 Commercial Insurance reimbursement: $85 (Report $5, commercial insurer did not
reimburse for $5 increased cost of post-pandemic office visit)
• Example 4 Commercial Insurance reimbursement: $85 + $5 insurer supplemental coronavirus related reimbursement (Report zero since insurer reimbursed for $5 increased cost of
post-pandemic office visit)
• Example 5 COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing,
Treatment, and Vaccine Administration for the Uninsured: $80 (Report $5 as expense
attributable to coronavirus but unreimbursed by other sources)