Medicare Compliance & Reimbursement

Tip: Register new CDC guidance.

As the feds release, retract, and change COVID-19-related policies daily, it’s easy to fall behind. And many providers are struggling to keep up with the new requirements — even though some regulations have been eased under 1135 blanket waivers — while assisting patients electronically or under reduced hours to comply with social distancing standards.

Tip: Though your organization may be operating with reduced staff, you should nominate an employee to do a daily check of the numerous Department of Health and Human Services’ (HHS) sites and auxiliary agencies, your Medicare Administrative Contractor’s (MAC) guidance, state and local health departments’ updates, and private payers’ online guidelines, experts advise.

Some of the public agencies, departments, and organizations work in tandem while others have released information that varies significantly from the federal output. That’s why it is critical to review daily the different releases that relate to your jurisdiction, state, and town while addressing private payers’ differences — many of which contradict the feds’ policies.

1. New Medicare Provider FAQs With Dates

Since HHS Secretary Alex Azar announced the public health emergency (PHE) on Jan. 31 and President Trump declared a national emergency on March 13, the Centers for Medicare & Medicaid Services (CMS) has issued numerous Medicare fee-for-service (FFS) releases. On April 17, the agency compiled billing guidance specifically for FFS providers into a handy 38-page FAQ set.

The helpful questions cover various subcategories on hot topics like telehealth, lab services, emergency care, COVID-19 testing, billing and coding, and more. An added bonus: CMS tags each question with a date that identifies when it was posted, if it’s new, or when it was last updated.

See the FAQs at www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf.

2. Expansive Blanket Waiver Summary

On April 15, CMS updated its 1135 blanket waiver guidance with a 29-page summary. The summary covers every Medicare area and offers links, definitions, guidance, and contact information. Plus, due to the rapid onset of COVID-19 in the United States and its continued hold on the nation, the blanket waivers “are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration,” CMS says.

The summary shows a laundry list of waivers for providers and suppliers, including the following highlights:

• A myriad of flexibilities for hospitals, psychiatric hospitals, critical access hospitals (CAHs), cancer centers, long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), rural health clinics (RHCs), federally qualified health centers (FQHCs), and inpatient rehabilitation facilities (IRFs)
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) waivers
• A cache of flexibilities for home health agencies (HHAs) and hospices
• Waivers related to beneficiary care for home dialysis and end-stage renal dialysis (ESRD)
• Flexibilities for physician services, nursing services, anesthesia services, and more
• Appeals flexibilities for Medicare FFS, Medicare Advantage (MA) and Part D providers
• Blanket waivers for sanctions under the Physician Self-Referral Law or Stark Law

Review the summary at www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.

3. Telehealth Guidance Related to RAPS for Medicare Advantage

On April 10, CMS finally issued telehealth services guidance for MA, Programs of All-Inclusive Care for the Elderly (PACE), and Cost and Demonstration programs related to the Risk Adjustment Processing System (RAPS) and the Encounter Data System (EDS).

“Under the guidance, Medicare Advantage organizations and other organizations that submit diagnoses for risk adjusted payment purposes are able to submit diagnoses that are from telehealth visits when those visits meet all criteria for risk adjustment eligibility, including being from an allowable inpatient, outpatient, or professional service, and from a face-to-face encounter,” explains Washington D.C.-based attorney Christine M. Clements, a partner at Sheppard, Mullin, Richter & Hampton LLP in a SheppardMullin Healthcare Law blog post.

See more details in the brief at www.cms.gov/files/document/applicability-diagnoses-telehealth-services-risk-adjustment-4102020.pdf.

4. Two New OCR Notifications of Enforcement Discretion

On March 17, the HHS Office for Civil Rights (OCR) issued its first COVID-19-inspired notification of enforcement discretion, which eased up on HIPAA penalties for noncompliance. In addition to this original notification that focused primarily on the best way for providers to navigate HIPAA while using non-public facing applications for telehealth, OCR also released extensive guidance on remote communications during the pandemic (see Medicare Compliance & Reimbursement, Vol. 46, No. 7).

Now: OCR issued two additional notifications to address COVID-19, data sharing, and HIPAA.

April 2: OCR announced that it will not impose penalties on covered entities (CEs) and their business associates (BAs) for “certain provisions of the HIPAA Privacy Rule” when patients’ protected health information (PHI) is used or disclosed for PHE-related matters “in good faith,” particularly with CMS, the Centers for Disease Control and Prevention (CDC), or state and local health agencies dealing with COVID-19.

“Granting HIPAA business associates greater freedom to cooperate and exchange information with public health and oversight agencies can help flatten the curve and potentially save lives,” stressed Roger Severino, OCR Director in the release.

Peruse the April 2 notification at www.hhs.gov/sites/default/files/notification-enforcement-discretion-hipaa.pdf.

April 9: Certain CEs, BAs, and large pharmacy chains will not have penalties imposed for noncompliance with specific provisions of the HIPAA Rules when participating in the feds’ COVID-19 community-based testing program, an OCR release suggests. This specifically impacts providers, BAs, and pharmacies operating and testing patients at COVID-19 Community-Based Testing Sites (CBTS) across the nation.

“This exercise of enforcement discretion is effective immediately, but has a retroactive effect to March 13, 2020,” OCR says.

View the April 9 notification at www.hhs.gov/sites/default/files/notification-enforcement-discretion-community-based-testing-sites.pdf.

5. CDC Return-to-Work Guidance for HCP

On April 8, the CDC offered “interim guidance” on healthcare personnel (HCP) returning to work after COVID-19 exposure. According to the update, organizations should base their decisions on allowing HCP to return on two options:

Test-based strategy: This option includes checking for resolution of fever and symptoms without medication and “negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected 24 hours apart (total of two negative specimens),” advises the CDC.

Non-test-based strategy: For this action plan, HCP must be both fever-free without fever-reducing medications and without symptoms for three days and must be seven days out from the first appearance of symptoms.

Tip: CDC cautions HCP to check with local and state requirements in addition to federal guidelines before returning to work because they vary widely based on location and COVID-19 hot spots.

Review the interim guidance at www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html.

Disclaimer: Information related to COVID-19 is changing rapidly. This information was accurate at the time of writing. Be sure to stay tuned to future issues of Medicare Compliance & Reimbursement for more information. You can also refer to payer websites, CMS (cms.gov), CDC (cdc.gov), and AAPC’s blog (www.aapc.com/blog) for the most up-to-date information.