Private Practice Financial Resources

• CARES Act Provider Relief Fund Frequently Asked Questions (FAQs)

• On September 24, 2020, AAPM&R Advocates to Protect Provider Relief Fund Distributions

• On May 22, 2020, HHS announced a 45 day deadline extension for providers who are receiving payments from the Provider Relief Fund to accept the Terms and Conditions for Provider Relief Fund payments. This announcement means providers have now been granted 90 days from the date they received a payment to accept HHS Terms and Conditions or return the funds. Read more.

• HHS released additional updates regarding the CARES Act Provider Relief Fund. Some of those updates are listed below and full details along with some of AAPM&R's considerations can be found here from our May 8 news story.  

• On April 22, 2020, HHS announced it is adding an additional $20 billion to the original $30 billion for what it describes as a $50 billion “general allocation.” The initial $30 billion was distributed between April 10 and April 17, and the remaining $20 billion is being distributed beginning Friday, April 24. The remaining fund distribution will be based on 2018 net patient revenue, not just Medicare fee-for-service. 
  
  Of the remaining $50 billion, $10 billion will be allocated for a targeted distribution to hospitals in areas that have been particularly impacted by the COVID-19 (application open as of 4/23); $10 billion for rural providers distributed as early as next week (no application needed); $400 million for Indian Health Services; there is an unspecified amount of funding allocated for treatment of the uninsured; and additional unspecified amount of funding for skilled nursing facilities, dentists, and providers that solely take Medicaid.

• On April 16, 2020 the CARES Act Provider Relief Fund Payment Attestation Portal officially opened. Providers who have been allocated a payment from the initial $30 billion general distribution must sign an attestation confirming receipt of the funds and agree to the terms and conditions within 30 days of payment. Due to the nature of the portal, AAPM&R has not yet been able to access the language in the attestation. We understand the portal has a variety of steps, including confirmation of eligibility, billing TINs, verifying payment information, attestations (likely related to the terms and conditions), and confirmation.
  
  Providers can contact UnitedHealth Group’s Provider Relations department at (866) 569-3522 about eligibility, whether a payment has been issued, and where it was sent. 

• On April 10, 2020, the U.S. Department of Health and Human Services (HHS) announced that $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American health care system. This $30 billion is part of the CARES Act that provides $100 billion in relief funds to hospitals and other health care providers on the front lines of COVID-19.
  
  

  These are payments, not loans, to health care providers, and will not need to be repaid. However, there are terms and conditions attached to these payments. We’ve collected the updates specific to you as a physician and you can view the full announcement from HHS.

  
  

Paycheck Protection Program

UPDATES:

• February 2021: Fact Sheet—Increasing Lending to Small Businesses in Need, White House Announces Changes to PPP to Further Promote Equitable Access to Relief

• February 2021: COVID-19 Paycheck Protection Program Omnibus Update—Apply Today To Help Protect Your Small Business Or Nonprofit. In this resource, you'll learn who is eligible to apply, the terms of PPP loans under the new law, what tax liabilities PPP loans carry and more.

• July 2020: An extension of the Paycheck Protection Program (PPP) application deadline was officially passed on Saturday, July 4, to allow for businesses to continue applying for PPP aid. The new deadline to apply for PPP loans - for businesses with fewer than 500 employees - is now August 8, 2020. The bill's proposed extension of the PPP comes after the program was set to end with more than $130 billion left of unused funds for the taxpayer program. As of Tuesday, June 30, the latest data from the Small Business Administration (SBA) shows the program lent more than $520 billion in emergency loans to more than 4.8 million American small businesses. The loans are intended to help businesses keep employees on the payroll, can range up to $10 million per loan, and can become grants.

• May 15: The SBA, in consultation with the Department of the Treasury, released the PPP Loan Forgiveness Application and detailed instructions for the application. The form and instructions inform borrowers on how to apply for forgiveness of their PPP loans, consistent with the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). SBA will also soon issue regulations and guidance to further assist borrowers as they complete their applications, and to provide lenders with guidance on their responsibilities. The documents released on May 15 will help small businesses seek forgiveness at the conclusion of the eight week covered period, which begins with the disbursement of their loans. View the application and instructions here.

• On April 24, in response to AAPM&R's letter to Congress regarding the fourth COVID-19 package, the “Paycheck Protection Program and Health Care Enhancement Act” (“COVID 3.5”), was officially signed into law. The bill provides $484 billion in additional funding to replenish and supplement key programs under the CARES Act, including the PPP, small business disaster loans and grants, hospitals and health care providers, and testing. The small business loan programs authorized under the CARES Act had been quickly depleted after only two weeks of operation. View specific components of the bill here.

• On April 16, the U.S. Small Business Administration released a notice regarding new applications: SBA is unable to accept new applications at this time for the Paycheck Protection Program or the Economic Injury Disaster Loan (EIDL)-COVID-19 related assistance program (including EIDL Advances) based on available appropriations funding. EIDL applicants who have already submitted their applications will continue to be processed on a first-come, first-served basis. AAPM&R is advocating for a quick solution to provide more funding and we will share updated information when available.

Quick Links:

• Application for a Paycheck Protection Program Loan 
• Paycheck Protection Program Summary Fact Sheet from AAPM&R
• Paycheck Protection Program Check List from AAPM&R
  

To help you sort through the abundance of information, we have collected a variety of resources to help our physiatrists who may need small business assistance:

• U.S. Small Business Administration Interim Final Rule On April 2, 2020 the U.S. Small Business Administration (SBA) released an interim final rule that provides guidance on the provisions in the CARES Act, including:
  • Eligibility requirements (page 5)
  • A maximum loan amount of $10 million and a guide as to how to calculate your maximum loan amount (pages 8-10)
  • Loan maturity of 2 years, rather than 10 years as the CARES statute originally provided (page 12)
  • A loan interest rate of 1% (page 12)
  • First payment deferred for 6 months, rather than 1 year as indicated in the CARES statute
    The amount of loan forgiveness can be up to the full principal amount of the loan and any accrued interest. 75% of the loan forgiveness amount must be attributable to payroll, rather than operational costs (pages 13-15)
  • The applicant must submit SBA form 2483 (page 15)
  • The full rule is located here. Please note:
    • The first 18 pages are useful to borrowers
    • Pages 19-27 are useful to lenders
    • Pages 28-31 are administrative law tasks to ensure the loans are legal
      

• Loan Information from the SBA
  • The Paycheck Protection Program authorizes forgivable loans to small businesses to pay their employees, their rent, and other operational costs during the COVID-19 crisis.
  • Small businesses can apply for the Paycheck Protection Program loans beginning Friday, April 3.
  • The application form can be found here. Practices should find and contact their lender to determine what additional information they require. According to the U.S. Treasury Department, borrowers may “apply through any existing SBA lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System Institution that is participating. Other regulated lenders will be available to make these loans once they are approved and enrolled in the program. You should consult with your local lender as to whether it is participating.”
• Assistance for Small Businesses from the U.S. Department of the Treasury
• A summary of the Paycheck Protection Program from Hart Health Strategies
• FAQs of the Paycheck Protection Program from Hart Health Strategies

Accelerated Payment and Advance Payment Programs

In these programs, physiatry practices may essentially borrow against their expected future Medicare payments in order to maintain necessary financial resources during the COVID-19 crisis. The Accelerated Payment and Advance Payment Programs are different than the Provider Relief Fund and the Paycheck Protection Program. View more information in this fact sheet from CMS.

Updates:

• April 2020: The Centers for Medicare and Medicaid Services (CMS) has announced that it is suspending the Advance Payment Program, effectively immediately. Due to the additional funding for the Provider Relief Fund appropriated in the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, CMS is reevaluating the Advance Payment Program and will not be accepting any new applications. All pending and new applications for accelerated payments will also be reevaluated. CMS states that significant additional funding will continue to be available to hospitals and other health care providers through other programs, and we will keep the membership informed of any new developments.

Webinar Recordings

Lessons Learned: How to Navigate the COVID-19 Crisis from the Outpatient Setting

Originally recorded April 1, 2020

Designed so participants can hear and learn from those located in areas that were impacted early on in the crisis. This webinar focused on:

• Processes put in place because of COVID-19
• Processes that were changed because of COVID-19
• Staffing and supply management issues
• Telehealth/telemedicine

Panelists included:

• Michelle S. Gittler, MD, FAAPMR – from Schwab Rehabilitation Hospital & Care Network
• Matthew J. Grierson, MD, FAAPMR – from Seattle Spine and Sports Medicine
• Andre Panagos, MD, FAAPMR – from Spine and Sports Med of New York PC

Critical Conversations: Private Practice Experiences During the COVID-19 Pandemic

Originally recorded April 2, 2020

This member-to-member conversational webinar gave participants the opportunity to ask their questions about small business loans, furloughing employees, and rapidly implementing telemedicine.

Panelists included:

• Mehul J. Desai, MD, MPH, FAAPMR – from International Spine, Pain and Performance Center in Washington, DC
• Larry H. Chou, MD, FAAPMR – from Premier Orthopaedic and Sports Medicine in Havertown, PA
• Annie D. Purcell, DO, FAAPMR – from Redding Spine and Sports Medicine in Redding, CA

AAPM&R's Update on Financial Relief for Physiatrists

Originally recorded April 7, 2020

This discussion covered new opportunities for practices including the Medicare Accelerated and Advance Payment Program and the Small Business Administration's (SBA) loans.

Panelists included: 

• Stuart J. Glassman, MD, FAAPMR – from Granite Physiatry in Concord, NH
• Peter Thomas – from Powers Law in Washington, DC
• Kathleen Hatfield – from Powers Law in Washington, DC

PM&R Recruitment, Job Placement, and Supplementing Income During the COVID-19 Pandemic

Originally recorded April 20, 2020

Despite millions of jobs being affected due to COVID-19, recruiting is still taking place. This panel discussion featured PM&R recruiters who provided insights into what is happening with job placements. 

Panelists included:

• Randy Awni – Co-Founder of Miner/Mason & Associates in Los Angeles, CA
• Marc Duerden, MD, CIME, FAAPMR – from Indiana Medical Examinations in Indianapolis, IN
• Tony Stajduhar – President of Jackson Physician Group in Alpharetta, GA

How PM&R Private Practices are Thinking about Re-Opening

Originally recorded May 5, 2020

A few weeks ago we heard from private practice members about their experience in laying off or furloughing staff, whether or not they applied for a small business loan, and how they began ramping up telemedicine efforts. We are catching up with a few of those members on how they are doing now and what their plans are for preparing to re-open their practices. Join this webinar to hear if they received loans, how patient visits are going, how their office culture has changed, and what specific plans they are working on for when they can slowly re-open.

Panelists included:

• Larry H. Chou, MD, FAAPMR – from Premier Orthopaedic and Sports Medicine in Havertown, PA
• Mehul J. Desai, MD, MPH, FAAPMR – from International Spine, Pain and Performance Center in Washington, DC
• Stuart J. Glassman, MD, MBA, FAAPMR – from Granite Physiatry in Concord, NH
• Annie D. Purcell, DO, FAAPMR – from Redding Spine and Sports Medicine in Redding, CA

Other Resources

• Prepare Your Office for Re-opening: AAPM&R's Guide for PM&R Best Practices (June 3)
• PPE Available Through AAPM&R Collaborations (May 29)
• COVID-19: A Physician Practice Guide to Reopening from the American Medical Association (May 5)