COVID-19 Resources

Sort Results: Most Recent
  1. Proposed MPFS Revises 60-Day Rule, Has ‘Good’ Telehealth News, but Brings Complications

    Report on Medicare Compliance Volume 33, Number 25. July 15, 2024  | Author: Nina Youngstrom  | July 15, 2024 

    It’s déjà vu all over again now that CMS has proposed a change to a definition at the heart of the Medicare 60-day overpayment refund rule for the second time in two years, according to the 2025 proposed Medicare Physician Fee Schedule (MPFS) rule announced July 10.[1] This time around, though, CMS also would formalize a six-month runway for providers to investigate and quantify suspected overpayments...

  2. Ethical leadership and employee satisfaction

    Ethikos Volume 38, Number 3. July 01, 2024  | Author: Mujo Vilašević  | July 01, 2024 

    Why is ethical leadership important, and where does it fit in terms of the organization, its employees, and their satisfaction? Can employee satisfaction be a measure of an organization’s ethicality?...

  3. Confusion About Rules on Inpatient Admission Orders Could Cause Denials

    Report on Medicare Compliance Volume 33, Number 24. July 01, 2024  | Author: Nina Youngstrom  | July 01, 2024 

    After a Medicare patient is treated for a stroke in the emergency department (ED) on a Monday morning, the ED physician calls the hospitalist for an inpatient admission order. Although the hospitalist enters an inpatient admission order, the patient isn’t moved upstairs until very early Tuesday morning when a bed becomes available. It may not seem like a big deal—the patient is well cared for in the ED—but every moment as an inpatient matters, because Medicare requires a three-day consecutive inpatient stay before patients qualify for admission to a skilled nursing facility (SNF), which may be necessary for stoke patients...

  4. News Briefs: June 17, 2024

    Report on Medicare Compliance Volume 33, Number 22. June 17, 2024  | Author: Nina Youngstrom  | June 17, 2024 

    ◆ Evergreen Treatment Services in Washington state, which provides medication-assisted treatment for substance use disorders, agreed to pay $1.453 million to settle false claims allegations over double billing, the U.S. Attorney’s Office for the Western District of Washington said June 13.[1] Medicare started paying for drug treatment, including medically assisted treatment, in 2020. The U.S. attorney’s office said Evergreen submitted claims to Medicare for the period January 1, 2020, to July 2020. “The claims are paid weekly, and services are bundled: medications, counseling, therapy, toxicology testing, intake activities and periodic assessments are billed under one billing code,” the U.S. attorney’s...

  5. CityMD Pays $12M to Settle FCA Case Over UIP Claims, Gets DOJ Cooperation Credit

    Report on Medicare Compliance Volume 33, Number 22. June 17, 2024  | Author: Nina Youngstrom  | June 17, 2024 

    CityMD, which operates 177 urgent care centers in New York and New Jersey, has agreed to pay $12 million to settle allegations it billed the COVID-19 uninsured program (UIP) for COVID-19 tests provided to patients with insurance, the U.S. Department of Justice (DOJ) said June 7.[1] One of those patients, Stephen Kitzinger, was the whistleblower who set the False Claims Act (FCA) case in motion. In his complaint, Kitzinger alleged he entered his insurance information into CityMD’s electronic tablet but was told by a CityMD administrator she planned to delete the insurance information, and it never appeared in the patient...

  6. Pressured by Sanders to Stop ‘Give-Away,’ NIH Drafts Policy for Intramural IP; Extramural Next?

    Report on Research Compliance Volume 21, Number 7. June 06, 2024  | Author: Theresa Defino  | June 06, 2024 

    It isn’t often that HHS sends out a news release about a request for information (RFI) or that the NIH director tweets about it. Rarer still is when one triggers praise from Sen. Bernie Sanders, I-Vt.—a man seemingly perpetually perturbed by HHS and NIH...

  7. RPM, CCM Attract Audits, May Be Vulnerable to FCA Investigations

    Report on Medicare Compliance Volume 33, Number 20. June 03, 2024  | Author: Nina Youngstrom  | June 03, 2024 

    Although CMS has been encouraging the use of chronic care management (CCM) and remote patient monitoring (RPM), the services are being eyeballed for compliance with billing and other requirements, attorneys say. For example, the HHS Office of Inspector General (OIG) has reviews underway of RPM and has already released two audit reports on CCM, and recovery audit contractors are all over RPM...

  8. Why mental health parity should top healthcare organizations’ to-do lists

    Compliance Today - June 2024  | Authors: Venson Wallin, Gregg Mills  | June 2024 

    Clinicians, first responders, and other healthcare staff work in highly stressful environments that can create or exacerbate mental health and substance abuse issues. Clinician work environments were worsened by the COVID-19 pandemic when high volumes of extremely acute patients overwhelmed healthcare systems. These conditions contributed to talent leakage industry-wide, with many clinicians and nurses leaving their current roles or the industry altogether. Furthermore, student enrollment in medical school, nursing programs, and medical assistant programs is lagging, meaning the talent pipeline is less robust than before, presenting a challenge to filling residual staffing gaps...

  9. Part 2, part deux: New rules for SUD information sharing

    Compliance Today - June 2024  | Authors: David R. Shillcutt, Lisa Pierce Reisz  | June 2024 

    For anyone who has tried to navigate the outdated and cumbersome regulations governing the use and disclosure of substance use disorder (SUD) treatment records, a major overhaul to these regulations may provide a clearer path to improve care coordination, eliminate barriers to access, and reduce the stigma that has historically accompanied SUD diagnosis and treatment. In a Final Rule published on February 16, 2024, the U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA) and the HHS Office for Civil Rights (OCR), implemented comprehensive revisions to the existing Confidentiality of Substance...

  10. NY Medical College Clashes With OIG After Audit Questions $7.5M, PI Salaries, ‘Illegible Signatures’

    Report on Research Compliance Volume 21, Number 6. May 23, 2024  | Author: Theresa Defino  | May 23, 2024 

    New York Medical College (NYMC) officials thought the HHS Office of Inspector General’s (OIG) audit was wrapping up in December 2021, based on what “the original senior auditor” told them. But the auditor retired and work continued under a scope that was “significantly expanded, without clear explanation,” in the words of Salomon Amar, NYMC vice dean of research and senior vice president for research affairs for its affiliate, Touro University.[1]...

  11. Physician Settles FCA Case for $2M Over Unsupervised PA Services

    Report on Medicare Compliance Volume 33, Number 18. May 13, 2024  | Author: Nina Youngstrom  | May 13, 2024 

    A Michigan physician and his practice agreed to pay $2 million to settle false claims allegations over ear-care services provided by physician assistants (PAs) without supervision, the U.S. Attorney’s Office for the Eastern District of Michigan said May 8.[1]...

  12. SNF Provider Settles FCA Case Involving Waivers; 'Incorrect Reasoning' Raises Questions

    Report on Medicare Compliance Volume 33, Number 17. May 06, 2024  | Author: Nina Youngstrom  | May 06, 2024 

    In what’s apparently the first False Claims Act (FCA) settlement over alleged misuse of COVID-19 waivers, ReNew Health Group and ReNew Health Consulting Services, a nursing facility and skilled nursing facility (SNF) company, and two of its executives have agreed to pay $7.084 million, the U.S. Department of Justice (DOJ) said April 26.[1] According to the settlement, ReNew billed Medicare nursing home residents under the Part A SNF benefit based on their exposure to COVID-19 from March 1, 2020, to June 31, 2022, and justified it with waivers—including the waiver of the three-day qualifying inpatient hospital stay—although they allegedly didn’t...

  13. ESG: The monster to be tamed

    CEP Magazine - May 2024  | Author: Elizabeth Simon  | May 2024 

    ESG—environmental, social, and governance—has become the buzzword among businesses today. With Europe leading the way, U.S. companies are quickly catching up. Meanwhile, regulatory authorities are working hard to create standards that apply everywhere. The Securities and Exchange Commission (SEC) in the U.S. has recently increased its involvement in monitoring and regulating this area, leaving many companies unsure about their next steps. Adding to the uncertainty, California has introduced the new California Climate Accountability Package...

  14. Valuable OIG compliance advice for new healthcare entrants

    Compliance Today - May 2024  | Authors: Phoebe A. Roth, Stephanie M. Gomes-Ganhão  | May 2024 

    In November 2023, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released the General Compliance Program Guidance (GCPG). The GCPG is described as a “reference guide for the health care compliance community and other health care stakeholders.”[1] OIG specifically states the Guidance is not meant to “constitute a model compliance program” or be “one-size-fits-all,” but rather it is intended to set forth voluntary guidelines and compliance tips for all individuals and entities that play a role in the healthcare industry.[2]...

  15. The compliance officer’s challenge: Riding the technological wave in healthcare

    Compliance Today - May 2024  | Author: Melissa Andrews  | May 2024 

    I was cleaning out my research collection a couple months ago. One that caught my eye was an article about telehealth. This article was published in 2018, and the author’s perspective made me laugh. In the piece, the author discussed telehealth and how they did not believe it would ever catch on. They reasoned that it was not real healthcare, insurance would never pay for it, and patients would not want to talk to their providers over the phone because they wanted to see them face to face. Oh, how times have changed!...

  16. Compliance with Medicare’s updated 2024 split (or shared) visit policy

    Compliance Today - May 2024  | Author: Elin Baklid-Kunz  | May 2024 

    Split (or shared) visits—the current term used by the Center for Medicare & Medicaid Services (CMS)—allow non-physician practitioners (NPPs) and physicians who work for the same employer/entity to share patient visits on the same day by billing the combined work under the physician’s National Provider Identifier (NPI) and receive 100% of the Medicare Physician Fee Schedule (MPFS), or the NPP’s NPI for reimbursement of 85% of the MPFS...

  17. News Briefs: April 29, 2024

    Report on Medicare Compliance Volume 33, Number 16. April 29, 2024  | Author: Nina Youngstrom  | April 29, 2024 

    ◆ CMS said it still plans to revise the Medicare 60-day overpayment refund rule, according to the 2025 final rule on policy and technical changes to Medicare Advantage (MA), which was published in the April 23 Federal Register.[1] CMS proposed a change in the definition in the 2024 version of the MA rule and now says it “has received inquiries regarding this proposal and want to be clear that it remains under consideration and that CMS intends to issue a final rule to revise the definition of ‘identified’ in the overpayment rules as soon as is reasonably possible.” The 60-day...

  18. Another Extension of Telehealth Waivers Looks Promising; OCR May Update Security Rule

    Report on Medicare Compliance Volume 33, Number 15. April 22, 2024  | Author: Nina Youngstrom  | April 22, 2024 

    Congress will probably authorize Medicare to keep telehealth coverage rolling next year and maybe forever along the lines of the COVID-19 flexibilities, according to Kim Brandt, former principal deputy administrator of CMS. That would mean continued payments for services delivered everywhere by audiovisual and audio-only technology, she said. They’ve already been kept alive through the end of this year by the 2023 Consolidated Appropriations Act (CAA). “We’ll definitely see action in Congress on telehealth,” said Brandt, who also was the Senate Finance Committee’s general counsel for five years, at HCCA’s Compliance Institute April 16. “The expectation is they will be...

  19. Audits of COVID-19 UIP Claims Are Underway; Evolving HRSA Guidance May Be a Problem

    Report on Medicare Compliance Volume 33, Number 14. April 15, 2024  | Author: Nina Youngstrom  | April 15, 2024 

    Hospitals and other providers should keep an eye out for audits of claims they submitted to the COVID-19 uninsured program (UIP), which was run by the HHS Health Resources and Services Administration (HRSA)...

  20. News Briefs: April 15, 2024

    Report on Medicare Compliance Volume 33, Number 14. April 15, 2024  | Author: Nina Youngstrom  | April 15, 2024 

    ◆ Northwell Health in New York State has paid $650,000 in penalties and $400,000 in refunds to patients for allegedly misleading New Yorkers in search of COVID-19 tests in the throes of the pandemic, the New York State Office of the Attorney General (OAG) said April 12. The OAG alleged that Northwell Health “deceptively advertised three of its emergency departments in New York City and on Long Island as COVID-19 testing sites where New Yorkers could simply get a COVID-19 test, but then billed patients for emergency room visits.” According to the Assurance of Discontinuance, “Despite the fact that at...

  21. Despite ‘Error Promptly Rectified,’ Nursing Home Pays $100K for Tardy Access

    Report on Patient Privacy Volume 24, Number 4. April 11, 2024  | Author: Nina Youngstrom  | April 11, 2024 

    Earlier this month, the HHS Office for Civil Rights (OCR) announced it had imposed a $100,000 fine on a skilled nursing facility for providing a patient’s records to her son nearly six months after his request. However, the firm that owned the New Jersey facility at the time of the request decried as “highly unfortunate” the agency’s “insistence on a punitive outcome in this matter...particularly given the circumstances during the COVID-19 pandemic.”...

  22. OCR Doubles Down on Pixel Ban, Offers Examples of Unlawfully Disclosed PHI

    Report on Patient Privacy Volume 24, Number 4. April 11, 2024  | Author: Jane Anderson  | April 11, 2024 

    The HHS Office for Civil Rights (OCR) is reiterating—with strong language—that HIPAA covered entities covered (CEs) should avoid using web tracking technologies in situations that could reveal protected health information (PHI) or risk violating HIPAA regulations. However, the new bulletin raises questions about when tracker use is permitted...

  23. Revenue Cycle: CARES Act Relief Funds

    Complete Healthcare Compliance Manual 2024  | Author: Stephen Shaver  | April 2024 

    The Provider Relief Fund (PRF) is a $175 billion fund created by Congress to provide financial relief to healthcare providers in the wake of the COVID-19 public health emergency. Congress initially appropriated $100 billion dollars for PRF in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, passed on March 27, 2020, and later appropriated an additional $75 billion in the Paycheck Protection Program and Health Care Enhancement Act, passed on April 24, 2020. [2][3]...

  24. Revenue Cycle: Denials Management

    Complete Healthcare Compliance Manual 2024  | Author: Ronald L. Hirsch  | April 2024 

    To properly analyze the compliance risks of denials management requires stepping back and analyzing the factors that led to the denial. First, claim denials are a refusal of an insurer to pay for a patient’s healthcare services at a healthcare provider. These denials can be generally classified into several types, each with a different root cause and compliance risk. Here are some of the most common types of claim denials...

  25. Post-Acute Care: Skilled Nursing Facilities

    Complete Healthcare Compliance Manual 2024  | Authors: Todd Selby, Sean Fahey  | April 2024 

    Skilled nursing facilities (SNFs) offer services to Medicare beneficiaries if daily skilled care or rehabilitation services are ordered by a physician and performed by, or under the supervision of, professional or technical personnel. The services must be for an ongoing condition for which the beneficiary also received inpatient hospital services or for a new condition that arose during the SNF care for that ongoing condition.[3]...