CARES Act for Pediatricians Q&A

FAQ based on recent SOAPM and PPMA comments:

  1. In order to apply, you have to have billed a state Medicaid or CHIP program at least once since 1/1/18. (This is 91% of pediatricians.)

  2. If you already got money from the first $50B Medicare fee-for-service and volume tranches, you don’t qualify to also get money through this wave. If you got targeted money e.g for rural health clinics, you ARE eligible to apply.

  3. The exact formula of money you’ll get has not been disclosed to us. The declared intent is that you’ll receive the less of a minimum of 2% of a recent-year’s TOTAL patient revenue OR your actual March/April 2020 losses. However, CMS also wants to know your relative percent of Medicaid vs commercial patients. I can’t imagine they would want this data just for survey purposes. It’s possible that they’ll use some bonus formula to small practices who see high Medicaid extra money, even if their 2% of total volume is smaller than large practices that take little Medicaid/CHIP.

  4. As of 20 minutes ago, the portal was not yet open. Patience, Grasshopper.

  5. The AAP is FREAKIN’ ALL OVER THIS. There are AAP staffers WAITING BREATHLESSLY, BREATHLESSLY I TELL YOU, who want to create a nice FAQ with illustrations and calculations, etc on how to fill it out. However, it will take time to seek official clarification on what’s unclear, then publish our findings in a clear way. So please do not log in immediately and rush through, then demand that the AAP has done nothing to help explain the weird bits to you. This is not a first-come-first-serve program like the PPP was. You have time to get this all straight.

  6. This money is a grant and does not need to be repaid. It does come with a few weird political requirements, like you won’t use it for: pornography, abortions, gun control advocacy, marijuana distribution, gambling. Sorry, all you pediatric houses of chance.

  7. You can get a PPP loan and get money from this program.

  8. You have to apply. You cannot just wait for the money to magically appear in your bank account.


The portal is open here:

Please first read the instructions and the application!


Just curious, where does the 91% figure come from? I don’t take Medicaid or CHIP and it seems like many in my area don’t either. There are only a few practices near where I am that we can refer to that are accepting Medicaid. Maybe our area is just unusual? I am genuinely curious.

This is what my accountant says

  1. Among other terms and conditions, you’ll read that these funds are intended to be used only to “prevent, prepare for, and respond to coronavirus” and that “the Recipient shall submit reports as the Secretary determines are needed to ensure compliance with conditions that are imposed on this Payment.”
  2. Be sure you analyze your need for the funds and how the money will be spent. Know that these funds “may not be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse”.
  3. Don’t look at this as “free money”. Rather, look to see if you really need the funds. If your PPP funds and other cash reserves have you sitting good for now, it is recommended that you wait to apply for the HHS additional funds and only do so if you determine a real need.
  4. Speak with your healthcare attorney to review the analysis and your eligibility and ability to comply with the terms and conditions. Accepting these funds comes with compliance risks of which you should be certain that you have adequate office policies and procedures to accept and spend the money appropriately. is the source of the 9% figure.

You are correct; participation by pediatricians in Medicaid is very regional. This article (much older, but still useful) measures the proportion of non-safety-net (i.e. NOT academic centers, NOT FQHCs) pediatricians willing to take ALL new Medicaid patients (i.e. more stringent than “see some” or “see established Medicaid patients only”) by state. Texas and California unsurprisingly are lousy at 33%-ish each. Massachusetts and Vermont and high-paying Medicaid states (ND, SD, WY) are great at >90%.

When you say state Medicaid or CHIP does this apply to Tenncare MCO’s?

TennCare is Tennessee’s state Medicaid program. CoverKids is Tennessee’s CHIP program.

yes thank you for confirming

Dr Rao, where does it state that these funds are to “prevent, prepare for and respond to coronavirus”?
Why would they ask for loss of business data and compare 2019 with 2020? What is the intent of these funds?

I could not find this either but my accountant is pretty savvy and this was his email to me re using these funds…and hence asking the big brains on this forum

The AAP has posted a really strong FAQ already!
# Provider Relief Fund: Information and Resources

Dr Rao, I rely on facts provided by the feds. This is what HHS guidance says. (in their FAQ

What oversight and enforcement mechanisms will HHS use to ensure providers meet the
Terms and Conditions of the Provider Relief Fund payments? (Added 5/6/2020)
Failure by a provider that received a payment from the Provider Relief Fund to comply with any
term or condition can subject the provider to recoupment of some or all of the payment. Per the
Terms and Conditions, all recipients will be required to submit documents to substantiate that
these funds were used for increased healthcare-related expenses or lost revenue attributable to
coronavirus, and that those expenses or losses were not reimbursed from other sources and other
sources were not obligated to reimburse them. HHS will have significant anti-fraud monitoring
of the funds distributed, and the Office of Inspector General will provide oversight as required in
the CARES Act to ensure that Federal dollars are used appropriately.

The bold lettering is mine

Thanks…but how do you quantify that lost revenue and all the oversight wording kills me…Are we going to be documenting to death for a few 10-15k??..Will be following this thread to see what all of you are doing…PS noted you use eCW also…

Well, hey, $10-15K is about 75-100 visits, so as long as it’s less documentation than that many visits, it’s a deal :slight_smile:

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Dr Rao,
Read (and also ask your accountant to read it) the FAQ I linked in my last post. Its 36 pages of pure gold. Its from HHS, therefore from the horses mouth, and its full of ideas on how to use the funds. For example pay for your EMR, rent, health insurance (don’t do it through PPP, can’t double dip), your parking lot tent etc. from this Care Act funds. Keep records. According to HHS every patient is presumed to have Covid 19. In ECW its easy to determine lost revenue. I have EBO full version and can run any detailed report. HHS just wants an estimate of revenue loss. If you don’t have EBO, you can run registry reports (every ECW user has it, left panel registry> registry or Lookup Encounter) on all checked out encounters from Mar Apr for 2019 and 2020 and multiply by average payment per visit. It took me 5 minutes to run the registry. I do not how much they are going to pay. 2% of Annual Revenue OR Lost revenue OR just monies spent on Covid 19 testing, care etc (peanuts in $ terms for us) as the FAQ say lower figure. But it was for Medicare, not sure what the Medicaid formula is going to be.
Its free money, if you do it right and legally. If its left over, pay it back, no interest.

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I am currently completing the Application for the CARES Act Provider Relief Fund and I am unsure of what to document as the registration type. Does anyone have any feedback on this please?

Are you referring to Field 5? If so the options are listed in the instructions here:

I have a question regarding Field 13:Lost Revenue due to COVID. This is calling for information for time period March & April 2020 but our volume didn’t decrease until March & April therefore we didn’t/won’t see actual revenue loss until May/June due to timing of insurance payments. Any suggestions on how to account for this? Our revenues for March & April were up but that was due to our volume in Jan/Feb.


Anyone else waiting for their TIN confirmation? My app reads still processing but others seem to get thru that step quickly. Not sure where to even find support for this.

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The one that got me sad was that I could not use the funds to get a chimpanzee from the wild…