Changes to PHE waivers and recommendations for hospitals. Compliance must assist and advise on policy, process, contractual, and operational changes by May 2023.Continue reading
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Complex and billed at a higher rate, OIG added physicians billing for critical care evaluation and management services to the work plan.Continue reading
The increase in telehealth services by Medicare beneficiaries drives more scrutiny, audit, and enforcement actions by the Office of the Inspector General (OIG).Continue reading
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.
Illegal beneficiary inducements include: free insulin, deflated Medicare copayment, courtesy adjustments for injections, free glucometers and waived co-paymentsContinue reading
Health systems look to YouCompli to help them manage the regulatory change management process. They need to be able to make sure the right people were taking the right steps to properly comply with regulations – and they need a system to verify that all those steps were taken. Compliance professionals use it to communicate with regulators, auditors and their Board. They also use the data with colleagues to support operational efficiency and better patient care. (Case study: Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up to date.)
YouCompli serves as a single system of record, with analytics and Board reporting to help you verify that your organization is in compliance. That makes it easier for you and your colleagues to focus on patient care with confidence.
In this clip Scott Borsuk explains how YouCompli helps his compliance department verify that proper action has been taken while providing valuable data that can be used to increase department efficiency.
Watch more videos on this topic here and see how YouCompli can help your organization
Use YouCompli to prove your organization did what it needed to do based on the factors your Board, regulators or auditors care about. Perhaps you need to evaluate the status of all the regulations pertaining to RevCycle, or maybe you need to understand how many regulatory requirements have been completed by each department. YouCompli includes standard and customizable reports to instantly prove that that the right people have taken the right actions on the relevant regulation changes.
Clear, effective reports
- Dynamic reports: Show the health of your compliance program in real-time. Our custom reports summarize critical metrics to share with your Board or regulators.
- Examples include: your compliance posture, the rate of completion of regulatory obligations, and evidence of actions taken in good faith to achieve compliance.
- Proactive collaboration: Use code change and other regulatory change reports to help colleagues get ahead of regulatory and billing changes, minimizing unpaid claims and reducing risk of fines.
- Dashboard: The YouCompli dashboard provides a high-level view of the compliance burden across an organization. Configure the dashboard based on user preferences to see All Regulations, All Requirements, and All Tasks.
- Customized view: Filters and sort tools enable the user to narrow the display based on criteria like Status, Effective Date, and Accountable Party. This same system-wide data can be displayed in a dynamic Calendar View or Task View to drill down into the details of the regulatory response.
- Pinpoint specific issues and actions: Search the entire system to zero in on relevant and urgent data points. You can search by keyword, regulator, functional department, jurisdiction, assigned to, assigned by, and much more.
Measure and influence employee behavior
Attestation: YouCompli includes simple tools to communicate procedure changes and training opportunities to staff, providers, and business associates. Use these tools to measure awareness of relevant regulations and the subsequent changes to procedures and codes of conduct.
A complete regulatory change management solution
YouCompli is the only healthcare compliance solution that addresses all stages of regulatory change management. It helps you know what regulations are changing from agencies you care about. It helps you decide whether those regulations and changes apply to you. It gives you the tools to manage your response to regulatory changes, and it makes it easy for you to verify that your organization put forth best efforts to stay in compliance.
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