COVID-19 Resources

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  1. 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)...

  2. 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...

  3. 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.”...

  4. 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...

  5. 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]...

  6. 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...

  7. 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]...

  8. Patient Care: Telehealth and Telemedicine

    Complete Healthcare Compliance Manual 2024  | Author: Raul G. Ordonez  | April 2024 

    The terms “telehealth” and “telemedicine” are commonly used interchangeably, and their definitions may vary depending on the location or jurisdiction where defined. Generally, “telemedicine” refers to the delivery of healthcare whereby the healthcare provider can care for the patient from a remote location through the use of electronic telecommunication. The term “telehealth” commonly has a broader connotation that includes both provider-patient encounters as well as the use of electronic telecommunication for other health-related interactions including provider education, public health, and health administration.”[2] For purposes of this article, the terms will be used interchangeably, but with a narrower focus in the...

  9. OCR Fines Nursing Facility $100K in HIPAA Right-of-Access Case

    Report on Medicare Compliance Volume 33, Number 13. April 08, 2024  | Author: Nina Youngstrom  | April 08, 2024 

    In a new right-of-access case, the HHS Office for Civil Rights (OCR) has slapped a $100,000 fine on Essex Residential Care LLC, doing business as Hackensack Meridian Health, West Caldwell Care Center (WCCC), a skilled nursing facility in New Jersey, because it took 161 days to send medical records to a patient’s son. OCR was unswayed by WCCC’s arguments that it was in the midst of a lawsuit with the mother and son and in the throes of the COVID-19 pandemic, according to the notice of final determination.[1]...

  10. Resource: Sample Compliance Committee Meeting Agenda

    Complete Healthcare Compliance Manual 2024  | Author: Cornelia Dorfschmid  | April 2024 

    Regular Meeting of the...

  11. Resource: Sample Compliance Committee Meeting Minutes

    Complete Healthcare Compliance Manual 2024  | Author: Cornelia Dorfschmid  | April 2024 

    Regular Meeting of the...

  12. Post-Acute Care: Home Health

    Complete Healthcare Compliance Manual 2024  | Authors: Todd Selby, Elizabeth E. Hogue  | April 2024 

    Home health agencies (HHAs) provide services in the home of a patient and are covered services under the Medicare program. Many managed care insurance products also cover home health services. State Medicaid programs cover certain types of home health services but at a much lower level of reimbursement. While the premise of providing care in the home of a patient may seem like a simple concept, the Medicare regulations and guidance governing HHAs are complex, which can lead to numerous compliance issues...

  13. Resource: Contract Approval Checklist

    Complete Healthcare Compliance Manual 2024  | Authors: Jennifer McAleer, Ryan Stanberry  | April 2024 

    Email to: _​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​...

  14. Patient Privacy and Security: Hybrid Work Environment

    Complete Healthcare Compliance Manual 2024  | Author: Sheila Price Limmroth  | April 2024 

    Traditionally, employers have set expectations that employees physically show up at an office to perform their work assignments. Even jobs that could lend themselves to remote work had in the past required an in-person presence. In 2020, however, such workforce expectations changed with the onset of the COVID-19 pandemic. That summer, Owl Labs and Global Workplace Analytics (GWA) surveyed 2,025 full-time workers in the United States between the ages 21 and 65 at companies with 10 or more employees. The survey found that 80% of respondents expected to work from home at least three days per week after COVID-19 restrictions...

  15. Emergency Medical Treatment and Labor Act (EMTALA) 

    Complete Healthcare Compliance Manual 2024  | Author: Jennifer McAleer  | April 2024 

    The Emergency Medical Treatment and Labor Act (EMTALA), known as the “anti-dumping law,” was part of the Consolidated Omnibus Budget Reconciliation Act of 1986, resulting from hospitals “dumping” indigent emergency patients.[2] The statute was amended in 1988, 1989, 2003, and 2011...

  16. Health Information Management: Coding with ICD-10 Current Procedural Terminology/Healthcare Common Procedure Coding System (ICD-10-CPT/HCPCS)

    Complete Healthcare Compliance Manual 2024  | Author: Nancy L. Freeman  | April 2024 

    The Healthcare Common Procedure Coding System (HCPCS) is a standardized coding system for describing and identifying healthcare services and supplies. It is designed to allow for the efficient processing of claims from Medicare as well as other payers. There are three recognized levels of this coding system:...

  17. Drug Diversion and Prescribing Practices

    Complete Healthcare Compliance Manual 2024  | Author: Raul G. Ordonez  | April 2024 

    The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have defined drug diversion as “the illegal distribution or abuse of prescription drugs or their use for purposes not intended by the prescriber.”[2] Despite increased scrutiny in recent years, drug diversion continues to be both a major American societal problem and an enforcement risk area because of its impact and contribution to the opioid crisis. Since 2000, more than 500,000 people have died from opioid-related overdoses.[3] By 2017, the problem of opioid addiction and overdose had reached such significance that the HHS...

  18. Patient Care: Rehab

    Complete Healthcare Compliance Manual 2024  | Author: Nancy J. Beckley  | April 2024 

    Rehab is an enigma—it’s both a program and a service offering. It is more popularly described as therapy, or more specifically as physical therapy (PT), occupational therapy (OT), or speech-language pathology (SLP). How this therapy is delivered, billed for, and paid for is described in U.S. Statute; U.S. Code of Federal Regulations (C.F.R.); Centers for Medicare & Medicaid Services (CMS) policy manuals, including the Benefit Policy Manual and Claims Processing Manual; as well as in Medicare national coverage determinations (NCDs) and local coverage determinations (LCDs).[2] Risk identification, risk assessment, and risk mitigation spin on the specific single disciplinary or multidisciplinary...

  19. 340B Drug Pricing Program

    Complete Healthcare Compliance Manual 2024  | Authors: Mark Ogunsusi, Jason Reddish, William von Oehsen, Barbara Straub Williams  | April 2024 

    Section 340B of the Public Health Services Act, enacted in 1992, entitles certain safety-net hospitals and clinics—referred to as “covered entities,” to purchase outpatient drugs at discounted prices from drug manufacturers.[5] Companion legislation that amended Section 1927 of the Social Security Act requires drug manufacturers to enter into a Pharmaceutical Pricing Agreement (PPA) with the U.S. Department of Health & Human Services (HHS) to provide such drugs at or below a statutorily defined ceiling price as a condition of the manufacturers’ drugs being reimbursable under the Medicaid program and Medicare Part B.[6] These two pieces of legislation launched a new...

  20. External Investigations

    Complete Healthcare Compliance Manual 2024  | Authors: Peter C. Anderson, Ana-Cristina (Cris) Navarro, Steve McGraw  | April 2024 

    Medicare Fraud Strike Force Teams, utilizing the combined resources of federal, state, and local law enforcement entities, continue to investigate healthcare fraud, waste, and abuse at increasing levels. According to the U.S. Department of Health & Human Services Office of the Inspector General (OIG), in only three quarters of 2020, 2,386 criminal actions were launched and 3,075 indictments were rendered, resulting in $3.82 billion in investigative receivables.[4]...

  21. Patient Privacy and Security: Cyberattacks

    Complete Healthcare Compliance Manual 2024  | Author: Michelle O’Neill  | April 2024 

    Cyberattacks are attacks, via the internet, targeting an enterprise’s use of cyberspace for the purpose of disrupting, disabling, destroying, or maliciously controlling a computing environment or infrastructure—or destroying the integrity of the data or stealing controlled information. The individuals or organizations that carry out cyberattacks are typically called cybercriminals, and they use cyberattacks to cause damage, to create disruption, to enact revenge, for financial gain, and for purposes of cyberwarfare. Unfortunately, the healthcare sector remains the number one target for cyberattacks. This is primarily due to the value of the data that can be obtained from a successful attack and...

  22. Physician Compensation: Contracts and Compensation Models

    Complete Healthcare Compliance Manual 2024  | Author: Joe Aguilar  | April 2024 

    Financial arrangements between physicians and hospitals come in a variety of types; however, the majority fall under three main categories: employment agreements, foundation model agreements, and professional services agreements. With a variety of agreement types, compliance exposure risks related to physician contracts and compensation models for health systems have increased as well...

  23. Auditing

    Complete Healthcare Compliance Manual 2024  | Author: Mary M. Menard  | April 2024 

    Auditing is a discrete, planned event in which a focused and structured process is designed to independently evaluate a distinct area of the organization or practice. Audits help to ensure that the practice or organization remains vigilant in its compliance efforts. There are many types of audits, including internal and external audits and prospective and retrospective audits...

  24. Health Information Management: Patient Access, Information Blocking, and the 21st Century Cures Act

    Complete Healthcare Compliance Manual 2024  | Author: Patricia A. Markus  | April 2024 

    Since 2003, under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, individuals have had the right to access and obtain a copy of their own protected health information (PHI) from a healthcare provider or a provider’s business associate, subject to a few narrow exceptions.[2] However, due to a misunderstanding of HIPAA requirements and, in some cases, a desire to protect against competition, providers over the last few years have repeatedly been fined by federal regulators for Privacy Rule infractions. These include failing to provide access to PHI in a timely manner; denying access when access is permitted; failing...

  25. Patient Privacy and Security: Business Associates

    Complete Healthcare Compliance Manual 2024  | Author: Isabella A. Porter  | April 2024 

    When the Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996, the world of healthcare operations vis-à-vis technology differed vastly from today. How healthcare entities functioned shifted between then and 2009, when the Health Information Technology for Economic and Clinical Health Act (HITECH) was passed by Congress within the omnibus American Recovery and Reinvestment Act (ARRA). The healthcare industry was eager to acquire technology and to contract for services that would facilitate patient care, support efficient healthcare operations, enhance organizations’ ability to collect revenue, and minimize their risks...