COVID-19 Resources

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  1. CMS Transmittals and Federal Register Regulations, Jan. 5-20

    Report on Medicare Compliance Volume 31, Number 3. January 24, 2022  | January 24, 2022 

    Please note: This box includes all transmittals posted by CMS so far in 2022...

  2. News Briefs: January 24, 2022

    Report on Medicare Compliance Volume 31, Number 3. January 24, 2022  | Author: Nina Youngstrom  | January 24, 2022 

    ◆ The HHS Office of Inspector General (OIG) has updated its Work Plan, and items include a Provider Relief Fund audit of the balance billing requirement for out-of-network patients and a nationwide review of hospice beneficiary eligibility.[1]...

  3. New Audit of Outpatient Therapy Hits Claims Below Annual Threshold; PTA Cuts Took Effect

    Report on Medicare Compliance Volume 31, Number 3. January 24, 2022  | Author: Nina Youngstrom  | January 24, 2022 

    Another audit of outpatient physical, occupational and speech therapy by the supplemental medical review contractor (SMRC) is underway, and in a twist, this time it focuses on claims below the per-beneficiary annual threshold of rehab services.[1] CMS is required by statute to audit therapy claims above the $3,000 per-beneficiary threshold, but now it’s peeking behind the curtains of other claims as well...

  4. CMS Vaccine Mandate Is Universal With Supreme Court Ruling; Surveys Are Provider Specific

    Report on Medicare Compliance Volume 31, Number 2. January 17, 2022  | Author: Nina Youngstrom  | January 17, 2022 

    The Supreme Court has cleared the way for CMS to enforce its COVID-19 vaccine mandate nationally at hospitals and other facilities regulated by the Medicare conditions of participation, with state surveyors using guidance that has been at their disposal since Dec. 28. In a Jan. 13 decision, the high court ruled that HHS Secretary Xavier Becerra “did not exceed his statutory authority in requiring that, in order to remain eligible for Medicare and Medicaid dollars, the facilities covered by the interim rule must ensure that their employees be vaccinated against COVID–19.”[1]...

  5. White Bagging Is Used to Cut Specialty Drug Payments, Lawyers Say

    Report on Medicare Compliance Volume 31, Number 2. January 17, 2022  | Author: Nina Youngstrom  | January 17, 2022 

    Health plans are using so-called white-bagging policies to reduce payments to hospitals for specialty drugs, and in the process, there may be a delay in patient care, attorneys say. Hospitals reportedly find white bagging thrust on them by Medicare Advantage plans and commercial payers in the middle of a contract year through amendments or policies, which means they won’t be paid for oncology and other high-cost specialty drugs they prepare for patients on-site. Some hospitals have resigned themselves to white bagging and are making up lost revenue in other parts of their payer contracts, while others try to scrap the...

  6. Privacy Briefs: January 2022

    Report on Patient Privacy Volume 22, Number 1. January 13, 2022  | Author: Jane Anderson  | January 13, 2022 

    ◆ New Jersey issued its third settlement in three months on state-level health care privacy and security laws, announcing that three cancer care providers would adopt new security measures and pay $425,000 to settle an investigation into two data breaches.[1] Acting Attorney General Andrew Bruck said that Regional Cancer Care Associates LLC, RCCA MSO LLC and RCCA MD LLC (collectively, RCCA) experienced breaches that potentially exposed personal and protected health information of 105,200 consumers, including 80,333 New Jersey residents. The first data breach occurred “when several RCCA employee email accounts were compromised through a targeted phishing scheme that allowed unauthorized...

  7. 2022 Outlook: More Dangerous Ransomware Coupled With Inadequate Security Practices

    Report on Patient Privacy Volume 22, Number 1. January 13, 2022  | Author: Jane Anderson  | January 13, 2022 

    As the COVID-19 pandemic enters its third year, real “security fatigue” with pandemic-related issues will combine with cybercriminals’ increasingly sophisticated capabilities to create an acceleration of ransomware and other security incidents, cybersecurity experts predict...

  8. Outlook 2022: COVID-19 Fraud May Factor in Cases 'Based on Different Allegations'

    Report on Medicare Compliance Volume 31, Number 1. January 10, 2022  | Author: Nina Youngstrom  | January 10, 2022 

    Although many enforcement targets will be familiar in 2022, with whistleblowers and the Department of Justice (DOJ) pursuing kickbacks, medical necessity cases, Medicare Advantage fraud and other violations, there will be another dimension, lawyers said. The use of COVID-19 relief funds will be part and parcel of many false claims investigations into other matters, and DOJ again is putting the spotlight on the people who pull the strings in a corporate fraud case...

  9. Outlook 2022: New Year Brings Big Billing Changes, More Audits, Key Supreme Court Cases

    Report on Medicare Compliance Volume 31, Number 1. January 10, 2022  | Author: Nina Youngstrom  | January 10, 2022 

    To some extent, compliance predictions for 2022 are like the coronavirus itself with its variants—things are fluid and everyone will know more when they’re in the thick of it. That applies to the challenges of reverse-engineering waivers after the public health emergency (PHE) ends and complying with the No Surprises Act, which requires hospitals and other facilities to determine when patients are treated by out-of-network providers and how much to charge them. Other predictions for the new year come easier. Compliance professionals and attorneys foresee a surge of short-stay audits and Targeted Probe and Educate (TPE), confusion with the reversal...

  10. News Briefs: January 10, 2022

    Report on Medicare Compliance Volume 31, Number 1. January 10, 2022  | Author: Nina Youngstrom  | January 10, 2022 

    ◆ A North Carolina physician who at times has been the nation’s top-paid provider of balloon sinuplasty services was indicted for adulteration of medical devices, paying illegal remunerations, making and using materially false health care documents, mail fraud and conspiracy, the U.S. Attorney’s Office for the Eastern District of North Carolina said Jan. 5.[1] According to the indictment, from 2014 to 2018, Anita Louise Jackson of Raleigh, who owned the practice Greater Carolina Ear, Nose, and Throat, “billed Medicare more than $46 million for allegedly rendering more than 1,200 incidents of ‘balloon sinuplasty’ services to more than 700 patients,” the U.S...

  11. CMS Transmittals and Federal Register Regulations, Dec. 17, 2021-Jan. 6, 2022

    Report on Medicare Compliance Volume 31, Number 1. January 10, 2022  | January 10, 2022 

  12. The Provider Relief Fund: Reporting unreimbursed expenses and lost revenue

    Compliance Today - January 2022  | Authors: Lynn M. Barrett, Stephen Shaver  | January 2022 

    The reporting deadlines for healthcare providers who received payments under the Provider Relief Fund (PRF) to report on their use of the payments have begun. Perhaps the largest compliance challenge for providers in PRF reporting is demonstrating that the provider used the payment in accordance with the terms and conditions of the PRF, as well as the numerous items of guidance released by the Department of Health & Human Services (HHS) in connection therewith. Specifically, providers who received PRF funds must demonstrate that they applied the PRF payment toward eligible expenses that were not reimbursed by other sources or toward...

  13. Telehealth updates: 2022 Physician Fee Schedule proposed rule and ongoing enforcement

    Compliance Today - January 2022  | Author: Raul G. Ordonez  | January 2022 

    The COVID-19 pandemic has brought considerable transformation within the healthcare industry as well as uncertainty. Overnight, the pandemic elevated telehealth from a highly specialized and seemingly futuristic mode of care into a major component of today’s healthcare delivery system. Nearing two years since the onset of the COVID-19 public health emergency (PHE), however, the permanence of Medicare coverage for various categories of telehealth services is still in question. On July 23, 2021, Centers for Medicare & Medicaid Services (CMS) published the Calendar Year 2022 Medicare Physician Fee Schedule (MPFS) proposed rule,[1] which included a number of notable prospective updates regarding...

  14. The differences and similarities between American and Italian healthcare fraud, waste, and abuse laws: Part 3

    Compliance Today - January 2022  | Authors: Pamela Coyle Brecht, Paola Sangiovanni, Marc Stephen Raspanti  | January 2022 

    Italian enforcement against fraud and corruption, including in the healthcare field, has traditionally been reserved to criminal courts, with no specific effort to coordinate or combine these actions through civil remedies. In light of the largely state-funded healthcare system in Italy, government corruption is in the foreground of efforts to detect and prevent fraud, waste, and abuse in healthcare. Egregious scandals erupted in Italian healthcare sectors, especially in the 1990s. Perhaps the most notorious case involved Dr. Duilio Poggiolini, the Ministry of Health’s general manager of the pharmaceutical department whose fortune included gold, jewels, and paintings of enormous value.[1] Poggiolini...

  15. RRC E-Alerts: December 16, 2021

    Report on Research Compliance Volume 19, Number 1. January 02, 2022  | Author: Theresa Defino  | January 02, 2022 

    Although a continuing resolution is now in place that funds the federal government through Feb. 18, 2022, committees are still working on bills that could contain provisions onerous to universities, the Association of American Universities (AAU) warned in its most recent weekly newsletter. AAU officials noted that some bills being debated have eliminated provisions requiring contractors for the Department of Defense (DOD) to “publicly available all diversity, equity, and inclusion training materials, internal policies, and other educational or professional materials ‘for review and identification of Critical Race Theory,’” which AAU and other groups oppose...

  16. NSF Award Mismanagement, Publication Ban Among Costly Actions by Researchers

    Report on Research Compliance Volume 19, Number 1. January 02, 2022  | Author: Theresa Defino  | January 02, 2022 

    During the second half of fiscal year 2021, which ended Sept. 30, the National Science Foundation (NSF) collected more than $2.5 million from six universities and a spinoff firm for a panoply of (sometimes alleged) mistakes and misdeeds. In four cases, NSF has either debarred the investigator involved or has been recommended to do so by OIG...

  17. Use technology to enhance compliance and data governance 

    CEP Magazine - January 2022  | Author: Alym Rayani  | January 2022 

    By Alym Rayani, MBA...

  18. Streamline policy management with a policy hierarchy

    CEP Magazine - January 2022  | Author: Swagata Roy  | January 2022 

    Written policies and procedures are foundations of an effective compliance program, enabling the organization to meet regulatory requirements, identify risk mitigation controls, and define roles and responsibilities for compliance. Compliance training, communication, and even monitoring activities are dependent on the quality and effectiveness of policy management...

  19. CO's Personal Experience With Waiver Raises Questions About Its Use, Discharge Planning

    Report on Medicare Compliance Volume 30, Number 45. December 20, 2021  | Author: Nina Youngstrom  | December 20, 2021 

    COVID-19 waivers got very personal for one compliance officer when a skilled nursing facility (SNF) refused to use the waiver of the three-day qualifying hospital stay to bill Medicare Part A for her 85-year-old aunt’s September admission after a total knee arthroplasty (TKA). As a result, the compliance officer picked up the tab for services that could have been covered by Medicare Part A, while the SNF billed Medicare Part B for rehabilitation. The situation was particularly troublesome because she said the same SNF was willing to bill Medicare fully with the waiver in June when her aunt had a...

  20. News Briefs: December 20, 2021

    Report on Medicare Compliance Volume 30, Number 45. December 20, 2021  | Author: Nina Youngstrom  | December 20, 2021 

    ◆ Correction: The Dec. 13 story on due diligence incorrectly stated that buyers should look at whether lease payments have been collected in a timely manner from referral sources.[1] The story should have referred to lease payments collected from tenants...

  21. Whether to Pay Ransom is Tricky Decision, But Few Get Data Back

    Report on Medicare Compliance Volume 30, Number 44. December 13, 2021  | Author: Nina Youngstrom  | December 13, 2021 

    When organizations are hit with a ransomware attack, they’re faced with a series of agonizing decisions that are getting more difficult to make as the cyber mafia operates more like a business yet isn’t reliable. Even if organizations pay the ransom, they’re unlikely to get back their data and may invite more attacks, and there’s a risk of penalties from the Office of Foreign Assets Control (OFAC),[1] experts say...

  22. The Role of Health Equity in Virginia's Pandemic Response

    2021 Richmond Regional Healthcare Compliance Conference  | December 2021 

    • Differentiate between equality and equity

    • Understand how health equity goals were designed into our pandemic response framework

    • Review the outcomes that Virginia was able to achieve through these efforts in vaccination, testing, and mitigation{br/}

  23. Virginia Legislative Update

    2021 Richmond Regional Healthcare Compliance Conference  | December 2021 

    • Understand the composition of Virginia's Legislative and Executive Branches

    • Review recent legislative and regulatory developments impacting health care in Virginia

    • Recognize the importance of engaging with policymakers

  24. How the Practice of Medicine Has Changed: Review and Verify 2021 E&M Changes and Telehealth Amidst a Pandemic

    2021 Richmond Regional Healthcare Compliance Conference  | December 2021 

    • Understand the changes underway before the start of the COVID pandemic and how they were accelerated as part of the response to the pandemic

    • Differentiate between the requirements for documentation based on the coding guidelines

    • Prepare for continued change as the value of non-face-to-face interactions is recognized in policy

  25. Facing Escalating Attacks, AHA Presses OCR to Expedite Security Practices Rule

    Report on Patient Privacy Volume 21, Number 12. December 09, 2021  | Author: Theresa Defino  | December 09, 2021 

    Amid the letters of congratulations to new HHS Office for Civil Rights (OCR) Director Lisa Pino is a plea from the American Hospital Association (AHA): “victims” of escalating health care attacks need OCR to quickly identify security practices as required under a law enacted in January...