The Coronavirus Aid, Relief, and Economic Security (CARES) Act was a significant piece of legislation that included substantial funding for healthcare providers. This funding, known as the Provider Relief Fund (PRF), was established to support hospitals and other healthcare entities facing financial strain due to the COVID-19 pandemic. Administered by the Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA), the PRF allocated $178 billion across multiple acts, including the Paycheck Protection and Health Care Enhancement Act, and Consolidated Appropriations Act, 2021.
The primary goal of the CARES Act Healthcare Relief Program was to reimburse healthcare providers for expenses and lost revenue directly related to COVID-19. This financial assistance aimed to ensure continued access to healthcare services for all Americans during the public health crisis, particularly for COVID-19 testing and treatment.
One crucial aspect of the PRF program involves specific terms and conditions that recipient hospitals must agree to. Among these is the “balance billing requirement.” This requirement stipulates that hospitals receiving PRF payments cannot seek out-of-pocket payments from patients presumed or confirmed to have COVID-19 that exceed what they would have paid for in-network care. This measure effectively prohibits “surprise billing” for COVID-19 related inpatient treatment for out-of-network patients.
To ensure compliance with this critical balance billing requirement, a nationwide audit will be conducted. This audit will scrutinize how hospitals calculated bills for out-of-network COVID-19 inpatients, examine supporting documentation, and evaluate the procedural controls implemented to guarantee adherence to the balance billing stipulation. The audit aims to safeguard patients from unexpected and excessive medical bills during a health crisis and uphold the integrity of the CARES Act Healthcare Relief Program.
