COVID-19 Lump Sum Payments for RHCs and FQHCs

RHCs and FQHCs may request lump sum payments for administering COVID-19 vaccines in advance of cost report settlement. CMS, through your MAC, will pay you up front for COVID-19 vaccines and administration at 100% reasonable cost like influenza and pneumonia vaccines.

RHCs or FQHCs with National Government Services should submit a request for a lump sum adjustment to NGSReimbursement@anthem.com. The request should include a statement that they wish to receive a lump sum adjustment based on the flu and pneumococcal vaccine costs from the most recent cost report or that they are providing 60 to 90 days of actual COVID-19 vaccine and administration cost data. If they choose actual costs, they will need to provide either a pro forma cost report through Worksheet B-1 (224-14 for freestanding FQHCs and 222-17 for freestanding RHCs) or the applicable cost reporting form for hospital-based. Or, summarize COVID-19 vaccine costs similar to what would be included on Worksheet A line 48 and 49 (224-14 for freestanding FQHCs) Worksheet A line 30 and 31 (222-17 for freestanding RHCs) for pneumococcal and influenza vaccines and include COVID-19 Medicare injections and total injections. For hospital-based FQHCs and RHCs, you would provide COVID-19 costs from your records. The request should be signed by an officer/administrator. The request should also include contact information such as phone numbers and email addresses for the signor and any designated contact persons. We will review the submitted information and respond with a letter and lump sum adjustment within 30 days.

If you have any questions, please email them to NGSReimbursement@anthem.com.

Posted 4/5/2021