A provider looks at the CARES Act Provider Relief Fund Application and Attestation Portal on her desktop computer.

Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund

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EligibilityAdvocates Blog

Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund

Helping Uninsured Americans Access COVID-19 Testing and/or Treatment

Posted on Monday, August 17, 2020

Updated Friday, August 28, 2020: The deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020.

Providers still have time to apply for aid through the CARES Act Provider Relief Fund. Below you’ll find important information about this program that can help providers recover revenue lost to the COVID-19 crisis and help uninsured patients avoid unexpected medical bills related to coronavirus testing and treatment.

Information for Providers

The federal government has allocated $175 billion to the Provider Relief Fund (PRF) to be distributed to qualified health care service and support providers for:

  • Appropriate expenses
  • Lost revenue due to COVID-19
  • Helping uninsured Americans access COVID-19 testing and/or treatment

The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion, and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) appropriated $75 billion, to this program. The program is administered by UnitedHealth Group through a contract with the Health Resources & Services Administration (HRSA).

Payments from the Provider Relief Fund do not need to be repaid by providers who comply with the program’s terms and conditions.

Information for Uninsured Patients

According to HHS.gov: “Providers who participate in and are reimbursed from the HRSA COVID-19 Uninsured Program are not allowed to “balance bill” individuals who do not have health care coverage (uninsured).”

If you are an uninsured patient and you receive a bill for COVID-19 testing and/or treatment services which shows that a portion of the bill was paid for by the Health Resources & Services Administration (HRSA), you should contact your healthcare provider as you may not be responsible for the balance.

However, if your provider did not participate in the HRSA COVID-19 Uninsured Program or the care you received was not eligible for reimbursement from the program’s funds, you may be responsible for payment.

Applying for Reimbursement Through the CARES Act Provider Relief Fund



A provider looks at the CARES Act Provider Relief Fund Application and Attestation Portal on her desktop computer.

UPDATE: PROVIDERS – The deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020 to apply for Phase 2 General Distribution funding from the CARES Act Provider Relief Fund.

The deadline to apply for Phase 2 General Distribution funding has been extended to September 13, 2020. Providers should check the HHS.gov website for the latest updates on deadlines and requirements.

Key conditions for reimbursement from the Provider Relief Fund include:
  • Screening patients for health coverage to ensure they are uninsured.
  • Accepting the payment provided from the fund and refraining from further billing the patient.
  • Submitting to a post-payment audit.
  • Confirming that COVID-19 is the primary diagnosis (except in the case of pregnancy).
Additional points to keep in mind:
  • Reimbursement is generally at Medicare rates and payment is dependent upon available funding.
  • Qualifying health costs and services such as COVID-19 testing, office visits, telehealth, non-emergency transportation, and more, with dates of service/admittance on or after February 4, 2020, are eligible for reimbursement.
  • Claims cannot be repealed or reprocessed after submission.
  • To submit claims electronically, providers need a clearinghouse or similar relationship.
  • Providers must attest that the information submitted is correct (billing companies/revenue cycle vendors can attest to the accuracy of the information for the provider).

EligibilityAdvocates can help providers apply for reimbursement from the CARES Act Provider Relief Fund, navigate regulatory flexibilities related to COVID-19, and screen patients for insurance coverage.

Contact us for more information on the CARES Act Provider Relief Fund or to get started on the application process before the deadline.

By EligibilityAdvocates

A patient advocate helps a young mother and baby, and the blog title appears: Why Outsource Patient Eligibility Services?

Why Outsource Patient Eligibility Services?

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EligibilityAdvocates Blog

Why Outsource Patient Eligibility Services?

Posted on Thursday, July 30, 2020

An on-site patient eligibility service can significantly improve patient experiences, increase self-pay conversions, and reduce account cycle time. For the best results, patient eligibility services should be performance-based and you should choose a vendor who can provide both on-site patient advocates and cutting-edge technology.

Here are just a few reasons to outsource patient eligibility services:

A patient advocate helps a young mother and baby, and the blog title appears: Why Outsource Patient Eligibility Services?

Outsource patient eligibility to maximize
patient advocacy and reimbursement.

Establish a Culture of Patient Advocacy

Show your patients and everyone who belongs to your organization that your facility values and is committed to patient advocacy. The presence of a patient eligibility and enrollment service, on site and at no cost to patients, will do just that.

This service supports patients by:

  • Finding insurance coverage and/or enrolling them in health plans.
  • Identifying financial assistance opportunities and handling the application process for them.
  • Reducing their medical expenses.
  • Helping them navigate the financial aspects of their healthcare through financial counseling and education.
  • Alleviating patient financial stress and confusion.
  • Increasing patient engagement with one-on-one, in-person interaction.
  • And more.

However, the help that an internal eligibility team can provide is often inhibited by their limited hours. Most facilities’ eligibility employees work a typical 9:00 AM to 5:00 PM schedule, whereas EligibilityAdvocates’ outsourced services are available on site, including in the Emergency Department, at a minimum of 12 hours a day and 6 days a week (and up to 24 hours/day, 7 days/week – based on peak analysis). This significantly extends patients’ access to support.

The more support you offer your patients, the bigger impact you can make on your entire community’s economic outlook. Our patient eligibility services help patients and healthcare facilities financially; plus, we create job opportunities because we hire patient advocates from your local community to fill all our on-site positions.

Maximize Patient Advocacy & Reimbursement with a Team of Experts

When you outsource patient eligibility and enrollment, you can ensure your patients are served by patient advocates who specialize in this service and all the rules and regulations that impact it.

State and federal laws, as well as individual health plan and financial assistance program requirements, change regularly. And waivers are often enacted when national emergencies like the COVID-19 crisis occur.

EligibilityAdvocates monitors all policies and guidelines that determine whether a patient will qualify for assistance, what the patient must do to apply, and how your reimbursement will be affected. You and your patients don’t have to keep track of all these moving parts or risk missing a detail that results in a denied application or claim.

Our expertise also covers out-of-state Medicaid, denial prevention, and follow-up on unpaid/underpaid claims.

Utilize the Vendor’s Technology

In addition to patient advocates’ extensive knowledge and compassion, an outsourced patient eligibility service can bring innovative technology to the table as well.

At EligibilityAdvocates, we equip our patient advocates with technology that enables mobile patient screening, such as at bedside or in the field. This includes convertible laptops/tablets, HL7 for real-time notes, electronic forms automation software, data encryption in transit and at rest, intermediate saves of information, and photo capture for documentation of driver’s licenses, insurance cards, etc.

We also supply our clients with customized dashboards and reports that deliver near-real-time transparency and alerts. Plus, our pre-arrival workflow solution streamlines financial clearance and automates many tasks for Patient Access.

All our solutions are HIPAA-compliant and will adhere to your organization’s specific procedures and compliance standards.

Reduce Uncompensated Care and Improve Your Revenue Cycle

Partnering with a patient eligibility and enrollment service provider will reduce your write-offs and A/R days. When patients obtain health coverage and/or financial assistance, you get reimbursed at higher rates. And, the face-to-face meetings between patients and patient advocates result in higher conversion rates, increased point-of-service payments, and the establishment of patient payment plans.

When you choose EligibilityAdvocates, we will pursue every possible source of funding for each patient account – so your organization will always be the “payer of last resort.”

You’ll also improve your revenue cycle with the benefits of our pre-arrival workflow solution, which prevents integrity issues and errors that would otherwise cause payment delays, denials, underpayments, and rework.

Experience a Greater Return on Investment

Your ROI will be much higher when you outsource patient eligibility services in comparison to managing this work internally.

Costs accrued by in-house staff include payroll and benefits, hiring and (ongoing) training expenses, office space, and equipment (phones, computers, printers, desks, etc.). You’ll need to allocate money, time, and resources to these employees whether their performance earns it or not.

In contrast, EligibilityAdvocates offers contingent fee pricing, so you’ll only pay us a percentage of the reimbursement we collect, and you won’t have to worry about any of the typical labor costs an internal team would necessitate.

Keep Your Focus on Patient Care: Outsource Patient Eligibility Services

EligibilityAdvocates can handle all aspects of patient eligibility and enrollment for you so that your teams can devote their time and resources to providing quality patient care.

Contact us to learn more about how we can lower or eliminate your patients’ out-of-pocket costs and improve your revenue cycle.

Strengthen the financial situation of all stakeholders in your organization – outsource patient eligibility services to EligibilityAdvocates today.

By EligibilityAdvocates

EligibilityAdvocates COVID-19 Response - Thank You, ALL Healthcare HEROES!

EligibilityAdvocates COVID-19 Response

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COVID-19 Response

The coronavirus (COVID-19) is affecting all individuals and organizations in significant ways – physically, emotionally, and financially, to name a few. In addition to creating a national health emergency, more people are out of work and without insurance as a result of this crisis.

EligibilityAdvocates COVID-19 Response - Thank You, ALL Healthcare HEROES!

THANK YOU, from all of us at EligibilityAdvocates!

Thankfully, our patient advocates can continue serving patients during this difficult time. They have been classified as essential staff members and are working on-site to help patients obtain benefits and secure alternative payment methods (including COBRA).

We at EligibilityAdvocates would like to thank all those working in health care who are risking their own safety in order to protect and care for these patients and keep our communities healthy. You are truly health care heroes.

We also want to express appreciation for each one of our patient advocates who is making a critical difference in patients’ lives on the front lines as well.

You are health care heroes too, as you work to minimize the financial impact of this virus on individuals and families.

CMS Waivers

As you may be aware, the Centers for Medicaid and Medicare Services (CMS) issued emergency blanket waivers in response to COVID-19, which have a retroactive effective date of March 1, 2020 until the end of the emergency declaration.

We’d like to draw your attention to these changes in particular, as stated by CMS:

  • 3-Day Prior Hospitalization Waiver for SNF placement – “CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).”
  • CAH Length of Stay Waiver – “CMS is waiving the requirements that CAHs limit the number of beds to 25, and that the length of stay be limited to 96 hours under the Medicare conditions of participation for number of beds and length of stay at 42 CFR §485.620.”

States and territories may submit a request for a waiver of statutes and regulations related to Medicaid and CHIP programs using the 1135 waiver checklist; CMS provides these examples of flexibilities they may seek:

  • “Waive prior authorization requirements in fee-for-service programs.
  • Permits providers located out of state/territory to provide care to another state’s Medicaid enrollee impacted by the emergency.
  • Temporarily suspend certain provider enrollment and revalidation requirements to increase access to care.
  • Temporarily waive requirements that physicians and other health care professionals be licensed in the state in which they are providing services, so long as they have an equivalent licensing in another state; and,
  • Temporarily suspend requirements for certain pre-admission and annual screenings for nursing home residents”
Please see the complete COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers document or contact us for more information.

As always, we are here to help you navigate these new regulatory flexibilities and to assist your patients with the financial challenges they may be facing. We are all in this together as we work to protect the physical and financial health of your patients and their families.


A couple struggling with patient financial stress seeks the help of a patient eligibility service.

11 Statistics on Patient Financial Stress

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EligibilityAdvocates Blog

11 Statistics on Patient Financial Stress

Posted on Wednesday, April 1, 2020

Current research on patient financial stress demonstrates the significant strain that medical bills, health insurance premiums, and healthcare costs place on many Americans today.

In fact, a recent survey of U.S. adults found that more people (40%) fear the medical bills resulting from a serious illness than fear the illness itself (33%).¹

Here are 10 more revealing statistics related to patient financial stress:

1.)  55%The percentage of Americans who worry a “great deal” about the affordability and availability of healthcare. ²

2.)  73%The percentage of U.S. adults who are concerned about their ability to pay for healthcare costs if they become sick or injured. ³

3.)  $500 or lessThe healthcare costs that 42% of Americans can afford before having financial issues. ³

4.)  45% The percentage of U.S. adults who fear going bankrupt due to a major health event. ⁴

5.)  137.1 million The number of Americans who report having medical financial hardship. ⁵

6.)  58% and 60%The percentage of lower-income and higher-income households that consider the cost of medications a stressor, respectively. ⁶

7.)  57% and 56%The percentage of lower-income and higher-income households that view medical bills as a source of stress, respectively. ⁶

8.)  66%The percentage of Americans who are stressed by the cost of health insurance. ⁶

9.)  57% The percentage of Americans who have been surprised by a medical bill that they expected health insurance to cover. ⁷

10.)  82%The percentage of patients who say hospitals are “very” or “somewhat” responsible for surprise medical bills. ⁷

Reducing Patient Financial Stress

A couple struggling with patient financial stress seeks the help of a patient eligibility service.

A patient eligibility service can reduce patient financial stress.

Providing a patient eligibility service can reduce patient financial stress and show them that your facility is here to help.

EligibilityAdvocates’ patient eligibility service reduces patient financial stress by finding monetary sources to help pay their medical bills and by providing them with financial counseling through on-site patient advocates.

Both financial assistance and financial counseling can reduce patient financial stress and the confusion that often fuels it. By instituting a patient eligibility service at your facility, you can ensure that fewer of your patients fall within the statistics listed above.



¹ NORC at the University of Chicago / West Health Institute – “New Survey Finds Large Number of People Skipping Necessary Medical Care Because of Cost” (2018)
² Gallup – “Healthcare Once Again Tops List of Americans’ Worries” (2019)
³ The Physicians Foundation –  “The Physicians Foundation 2019 Patient Survey” (2019)
Gallup – “Americans Fear Personal and National Healthcare Cost Crisis” (2019)
⁵ Yabroff, K.R., Zhao, J., Han, X. et al. – Journal of General Internal Medicine (2019) 34: 1494. https://doi.org/10.1007/s11606-019-05002-w
American Psychological Association – “Stress in America™: Uncertainty About Healthcare” (2018)
NORC at the University of Chicago – “New Survey Reveals 57% of Americans Have Been Surprised by a Medical Bill” (2018)

By EligibilityAdvocates