Christi Grimm, the Inspector General of HHS, gave a recent keynote address to compliance professionals. In it, she said, “Simply put, the financial incentives created by risk adjustment may be driving upcoding in the severity of diagnoses to garner additional payments.”
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Healthcare organizations should benchmark the DOJ Evaluation of Corporate Compliance Programs (ECCP) guidance (March 2023) to assess their compliance program.
Continue readingPreparing for the End of the Public Health Emergency
Changes to PHE waivers and recommendations for hospitals. Compliance must assist and advise on policy, process, contractual, and operational changes by May 2023.
Continue readingThe Three Lines Model for Healthcare Compliance
Show that healthcare compliance and operations share responsibility for identifying and mitigating risks with the Three lines Model – a strategic partnership.
Continue readingFederal and State Agencies Preview 2023 Enforcement Trends
The MHA’s Healthcare Legal Compliance Forum Federal and State Enforcement Update in Dec. 2022 looks at Stark law violations, turbocharging, and 340b programs.
Continue readingCOVID-related enforcement actions
Trillions spent through the COVID public health emergency drive audit and enforcement actions from the government. What to do regarding PHE-related risks.
Continue readingTelehealth Enforcement
The increase in telehealth services by Medicare beneficiaries drives more scrutiny, audit, and enforcement actions by the Office of the Inspector General (OIG).
Continue readingTelehealth evolution: Supporting patients with virtual care
Improve patient care and protect your healthcare organization under evolving telehealth compliance requirements today. How to prepare for regulatory change.
Continue readingIs telehealth getting a new lease on life?
Through 2019, telehealth was mainly for rural patients living far from healthcare providers. Then came COVID and the Public Health Emergency (PHE) declaration from the Department of Health and Human Services (HHS). Since 2020, a series of rolling 90-day waivers opened telehealth to everyone, temporarily.
Thanks to a recent surge in COVID cases, the current PHE extends to October 2022. When it ends, so does CMS’s authority to continue telehealth’s expended capabilities (unless there’s a further extension). That’s why Congress stepped in. The Consolidated Appropriations Act, which became law March 15, extends telehealth’s lifespan by five months (151 days, to be specific) after the PHE expires. (Related: Six key steps to reduce the impact of telehealth audits)
That means telehealth is alive and well at least through year’s end. So are many of the PHE-related coverage flexibilities. Here are some of the highlights:
- Telehealth from anywhere Before the PHE, Medicare covered only services delivered to patients at hospitals and other provider facilities. The Act redefines “originating site” to mean “any site in the United States at which the eligible telehealth individual is located at the time the service is furnished.” This could be patients’ homes, their cars – anywhere with phone or Wi-Fi connectivity.
- More practitioners In addition to physicians, nurse practitioners, physician assistants and other specialized providers, occupational and physical therapists’, speech language pathologists’ and audiologists’ services will be covered.
- Payment for audio-only services will continue for 151 days after the PHE ends.
- Relaxed in-person mental health services requirement The waivers ensure that the requirement that mental health patients have in-person visits of the first telehealth visit and every 12 months afterwards won’t take effect until the 152nd day after the PHE ends.
- Reinstated first-dollar coverage Until the end of 2021, telehealth services to High Deductible Health Plan and Health Savings Account patients were not subject to plan deductibles. The new law reinstated this relief through December 31 of this year.
- More data transparency The Medicare Payment Advisory Commission is required to analyze telehealth utilization, expenditures, payment policies, and implications on access to and quality of patient care. Starting July 1, the HHS Secretary must publicly post quarterly telehealth utilization data.
For more lasting, but not permanent, relief, the bipartisan Telehealth Extension and Evaluation Act, which would extend the telehealth waivers for two years, is inching its way through Congress.
If all the flux and uncertainty at the federal level weren’t enough, there’s also the state level. As I posted almost a year ago, the states have their own telehealth coverage, reimbursement, and privacy regulations. For now, patients and providers can continue on through at least the end of 2022 with access to telehealth. Beyond that, healthcare organizations are working hard to future proof their approach to telehealth. Stay tuned!
Read how one health system created a scalable repeatable process to address regulatory changes during the PHE. The hospital system is now fully prepared to revert those changes or update them to the new requirements.