Compliance Today

  1. Integrating telehealth into compliance programs: Best practices for compliance professionals

    Compliance Today - August 2020  | Authors: Nick Merkin, Erin MacLean  | August 2020 

    Even before many Americans were affected by the novel coronavirus and the resulting stay-at-home orders, school closures, and business shutdowns, telehealth was one of the fastest-growing segments of healthcare. Telehealth, a broadly defined term, includes the remote delivery of care by medical professionals, along with an array of services and technologies, such as artificial intelligence, virtual reality, and other interactive platforms.[1] Telehealth’s potential to expand access to care at reduced cost while maintaining high standards of quality is well suited for today’s value-based care models. Additionally, as a solution to overcrowded emergency rooms and expensive clinic space, many healthcare providers...

  2. 2020: Abuse, misuse, and misunderstandings of modifiers -25, -59, and -62

    Compliance Today - August 2020  | Author: Sonal Patel  | August 2020 

    There is no easy way to say this, so I will state the simple facts. Over the years, the misuse and misunderstandings of modifiers in healthcare coding have led to the many spotlights set forth by the Office of Inspector General’s (OIG) Work Plan. The sheer volume of misuse and misunderstanding has often led to cases of identified abuse.[1] Moreover, with known intent thrown in the mix, this erroneous usage becomes fraud, according to the definitions set forth by the False Claims Act.[2]...

  3. Compliance program (and officer) effectiveness in a time of crisis

    Compliance Today - August 2020  | Author: Matthew D. Vogelien  | August 2020 

    “Lead through a crisis day in the same way you would an ordinary day.” Tammie Jo Shults, Southwest Airlines pilot...

  4. The power of persuasion

    Compliance Today - August 2020  | Author: Gerry Zack  | August 2020 

    Have you ever rolled out a new policy, procedure, or internal control, only to have it met with skepticism and a chorus of “Why do we have to do this?” Of course you have; we all have. Yet we sometimes still fail to understand why people ask it...

  5. How to mentor the next generation of compliance officers-millennials?

    Compliance Today - August 2020  | Author: Catherine Boerner  | August 2020 

    As you know, “millennials” is the name given to the generation following Generation X—those born between 1981 and 1996. The whole idea of naming generations and identifying differences based on how they were raised and educated as children can shed some light on how, as adults, they work in the workforce. Yes, this can be viewed as stereotyping, but there might be nuggets of truth that might make all the generations get along...

  6. Risks versus controls

    Compliance Today - August 2020  | Author: Margaret Hambleton  | August 2020 

    There are generally three significant components to completing a risk assessment: (1) identification of potential risk areas, (2) assessing the organization’s vulnerability to each risk, and (3) developing an action plan to address the risks that fall outside the organization’s risk tolerance. While there is a significant number of discrete steps within each component, I want to focus on one aspect of the risk identification process that often causes some confusion: identifying an actual risk versus a potential control weakness...

  7. Comfortable comfort in compliance

    Compliance Today - August 2020  | Author: Nancy J. Beckley  | August 2020 

    This year may be best described as “the year of living dangerously,” as we get ready to end the summer and look forward to a Labor Day weekend that signals the march to the end of the year. The disruption caused by the new skilled nursing facilities’ Patient-Driven Payment Model and the new home health Patient-Driven Grouping Model gave way to COVID-19 and helped declare a pandemic and a public health emergency...

  8. Virtual monitoring

    Compliance Today - August 2020  | Author: John Falcetano  | August 2020 

    As we have recently seen, pandemics can affect the way clinicians have to treat their patients. In an effort to reduce exposing vulnerable populations to COVID-19, physicians turned to technology and started using telehealth to remotely treat their patients more often, thereby reducing the chance of contracting the deadly virus. The pandemic also caused compliance professionals to rethink how they were monitoring for compliance. Many compliance professionals found themselves working remotely along with other staff to carry out their compliance functions. Compliance professionals had to evaluate compliance processes, such as monitoring activities, and find new ways to complete tasks...

  9. COVID-19: Into the unknown

    Compliance Today - August 2020  | Author: Jay P. Anstine  | August 2020 

    From scheduling patients to care delivery to reimbursement, healthcare is an industry functioning on a daily basis under highly technical processes and a mountain of regulations. Generally speaking, privacy professionals can serve to support leadership as they navigate these operational challenges with respect to protected health information (PHI). In this strange new world of COVID-19, there has been no shortage of opportunities to consult leaders on issues such as media access to PHI, safeguarding PHI with a remote workforce, and appropriate sharing of test results. While this list is not intended to be exhaustive, these are some issues you’ve encountered...

  10. The Provider Relief Fund: Welcome relief or compliance minefield?

    Compliance Today - August 2020  | Authors: Andrew B. Wachler, Stephen J. Shaver  | August 2020 

    The outbreak of COVID-19 has sent shock waves through the US economy. In the healthcare industry, hospitals and healthcare providers have seen nonessential but revenue-generating procedures postponed and distancing guidelines lead to steep declines in other services.[1] At the same time, they have seen a surge in actual and potential COVID-19 patients, as well as rapid increases in the prices of many basic medical supplies and equipment.[2] Caught between sudden expenses and a sudden drop in revenue, many hospitals and healthcare providers are struggling for operating capital[3] and some have shut down entirely.[4]...

  11. Comparative Billing Reports: Tools to support Medicare Part B providers

    Compliance Today - August 2020  | Authors: Kimberly Hrehor, Annie Barnaby  | August 2020 

    How do your billing and/or prescribing submissions compare to those of your peers? Even the most compliant process can benefit from comparisons and analyses of claims, billing, and/or prescribing data. To evaluate these data, develop provider education, and raise awareness of peer claim submission patterns, the Centers for Medicare & Medicaid Services (CMS) initiated the Comparative Billing Report (CBR) program in 2010...

  12. Compliance 101: Using a distribution analysis as a compliance tool

    Compliance Today - August 2020  | Author: Michael Spake  | August 2020 

    Detecting healthcare fraud and abuse is challenging even to a well-seasoned compliance auditor. The nature of healthcare services, unlike other service industries, is complex due to the uniqueness of the individual patient and their medical condition. In addition, variability among physician practices in the same specialty across different communities is significant (e.g., there are marked variations in the frequency of major procedures across different regions of the country and end-of-life hospital days).[1] This variation, coupled with the complex delivery of medical services, makes potential fraud and abuse practices difficult to identify, because variations in billing practices do not automatically indicate...

  13. Preparing for the era of provider network transparency

    Compliance Today - August 2020  | Authors: Michael Adelberg, John Weis  | August 2020 

    Transparency is one of the top buzzwords in healthcare today. In the last few years, we have seen the rollout of significant healthcare transparency initiatives focused on portable health records, hospital costs, drug costs, quality data, and many other things (e.g., Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First).[1] And yet, with a good deal less fanfare, healthcare policymakers have also put in place the changes necessary to usher in a new era in health plan provider networks—the era of provider network transparency. In the following paragraphs, we discuss the coming of provider...

  14. Telemedicine and the coronavirus crisis: Key legal issues for providers to consider

    Compliance Today - August 2020  | Author: Robin M. Singh  | August 2020 

    The novel coronavirus disease (COVID-19) has affected all areas of life and healthcare delivery...

  15. Department of Justice fines pharmaceutical company

    Compliance Today - August 2020  | Author: Sascha Matuszak  | August 2020 

    On May 7, the Department of Justice’s Antitrust Division announced a deferred prosecution agreement, in which Apotex Corp. agreed to pay a $24.1 million criminal penalty for price-fixing.[1] The Florida-based company conspired with competitors to increase and maintain the price of pravastatin, a commonly prescribed cholesterol medication that lowers the risk of heart disease and stroke...

  16. US Department of Justice charges co-owners of pharmaceutical company for fraud

    Compliance Today - August 2020  | Author: Sascha Matuszak  | August 2020 

    The Department of Justice’s Criminal Fraud division indicted six Texas-based owners and marketers for a scheme to defraud TRICARE and the U.S. Department of Labor, resulting in more than $14 million in illegal kickbacks and bribes.[1]...

  17. Pandemic may hamper investigations

    Compliance Today - August 2020  | Author: Sascha Matuszak  | August 2020 

    The pandemic is forcing people to stay at home and conduct work remotely, which is having an impact on time-sensitive investigations that require in-person interviews. In a webinar hosted by the American Conference Institute, Daniel Kahn, a senior deputy chief in the Department of Justice’s Criminal Division’s Fraud Section, told viewers that routine work that involves obtaining documents from overseas and interviewing corporate executives is delayed by stay-at-home orders.[1]...

  18. OSHA releases revised COVID-19 guidance

    Compliance Today - August 2020  | Author: Sascha Matuszak  | August 2020 

    The Department of Labor’s Occupational Safety and Health Administration (OSHA) released revised guidelines regarding enforcement actions during the COVID-19 pandemic.[1] There are two major changes: increasing in-person inspections as noncritical businesses start to reopen and requiring businesses to treat the coronavirus as a reportable illness during recordkeeping...

  19. Meet Andra M. Popa: Approaching compliance with a focus on design

    Compliance Today - July 2020  | Author: Roy Snell  | July 2020 

    Andra M. Popa, CHC, Consultant at Ankura Consulting Group, Chicago, IL, and Florida...

  20. Compliance with the new COVID-19 business assistance loans

    Compliance Today - July 2020  | July 2020 

    By Gabriel L. Imperato, Esq., and Romain Balard, Esq...

  21. Proactively addressing revenue integrity in the era of COVID-19

    Compliance Today - July 2020  | Author: Vasilios Nassiopoulos  | July 2020 

    The COVID-19 pandemic will undoubtedly leave a permanent imprint on the healthcare landscape. The heightened role of technology, especially as it relates to data access and analytics, is one area that will leave a lasting mark as a differentiator for care and operational efficiency, as well as actionable response...

  22. Considerations for incident response: What changes during a national healthcare disaster?

    Compliance Today - July 2020  | Author: Marti Arvin  | July 2020 

    Most healthcare organizations perform drills for a variety of situations. It might be an airplane crash at the local airport, a hurricane or tornado hitting the local community, a major fire or earthquake, or a cyberincident, but those are all relatively local incidents. While healthcare organizations in the affected area may have issues, they can generally rely on the support of other nearby facilities. The preparation is not the same when the entire country is hit with the disaster...

  23. Follow the money ... to your business associates

    Compliance Today - July 2020  | Author: Tiffany Holman  | July 2020 

    Are we still discussing business associate agreements (BAAs) after all this time? Yes, and privacy professionals continue to have questions and confront challenges. Here are a few questions that linger for privacy professionals:...

  24. Let's keep doing that

    Compliance Today - July 2020  | Author: Gerry Zack  | July 2020 

    Last month I wrote about managing new and changing risks in the face of crisis, specifically as it relates to the COVID-19 pandemic. This month, while the effects of the virus continue as I write this column in late April, another possibility has emerged—whether some of the “temporary” changes made to get through this, or any, crisis actually reveal efficiencies or improvements that warrant making the change permanent...

  25. COVID-19 emergency preparedness kit

    Compliance Today - July 2020  | Author: Catherine Boerner  | July 2020 

    As compliance professionals, I am sure all of you have discussed with your families a COVID-19 emergency preparedness family plan. My husband and I did it early on. We discussed where someone would quarantine (our master bedroom) and what they would need. I ordered a finger pulse oximeter, blood pressure wrist cuff, extra thermometers, and extra batteries. We didn’t buy extra toilet paper, but we bought extra bottled water, vitamin water, Gatorade, chicken noodle soup, and made a list of possible meals and filled the freezers with food...