Ophthalmology and Optometry Coding Alert

Practice Management:

Steer Clear of Post-PHE Snafus in 7 Simple Steps

Published on Wed Mar 22, 2023

Planning is paramount to ensure a seamless segue back to pre-PHE rules.

Healthcare industry buzz continues to be dominated by the announcement that the COVID-19 public health emergency (PHE) is coming to an end on May 11, more than three years after it was first implemented.

With the conclusion of the PHE looming, eye care practices are tasked with preparing for a return to normal standards. To make sure you have the knowledge needed to unwind pertinent PHE-era policies and practices, we put together this guide full of expert advice on steps to ensure a smooth transition.

Step 1: Start ASAP

While some of the popular waivers have been made permanent, others are set to expire at the end of the PHE. “Providers who are still relying upon waivers need to start acting now,” urges attorney Robert Markette Jr. with Hall Render in Indianapolis. The most important task, “especially now that we have a deadline, is to get moving,” Markette stresses.

“Once the PHE ends, unless otherwise noted, the waivers end,” Markette explains. “Providers need to be back to pre-PHE operations by May 11. If you are surveyed on May 12 and not back to ‘the old ways,’ you will almost certainly be cited,” he warns. “[Providers] should be using this time wisely. This will allow a planned, controlled rollout of new policies,” which are actually “the old pre-PHE policies,” he continues.

Bottom line: Begin reestablishing previous health and safety standards and billing practices. “We all remember the chaos around the waivers in 2020,” Markette recalls. “We can avoid that now because we have ample warning,” he says.

Step 2: ID Affected Policies

The first order of business is to identify those policies that your practice changed due to PHE waivers, so you can assess whether you will need to change them back — or transition to a new policy.

“As the PHE ends … flexibilities will go away and we will have to return to operating under” the original Medicare requirements, Markette observes. Some providers have already transitioned back to their old policies, either because their state PHE ended and their licensure required it, or because they simply no longer needed the leeway and were eager to make their transition to a post-PHE environment smoother.

“Indiana is a prime example” of the former, Markette says. “We are a licensure state. At the beginning of the pandemic, the state moved to waive certain licensure requirements. When the state ended the PHE last year, all of the state license waivers went away. This meant providers had to return to following state licensure requirements without the waivers. At that point, the Centers for Medicare & Medicaid Services (CMS) waivers did not matter,” he relates. So, don’t forget to check your own state’s policies.

Yet some providers never changed their policies to begin with, and now don’t have to switch back.

Step 3: Narrow Down Expiring Waivers

Once you’ve identified policies revised for the PHE, check and see whether the changes are being scrapped or have been extended or made permanent either via legislation or Medicare rulemaking, which includes telehealth flexibilities.

Example: During the PHE, CMS temporarily modified the requirement that a supervising physician be immediately available to also include circumstances where a supervising physician has a virtual presence via real-time audio and video technology. However, this Medicare flexibility will end with the PHE.

Also, make sure to pay attention to the particulars when evaluating your telehealth policies and procedures. While major telehealth flexibilities will remain in place until Dec. 31, 2024, the waivers that expanded the types of healthcare professionals who can provide telehealth services and allowed coverage for audio-only telehealth have only been extended to end 151 days after the PHE concludes.

Step 4: Create a Transition Plan, Put It in Motion

When you have your final list of policies that need to revert to pre-PHE rules, it’s time to draw up a plan for doing so. While the practice administrator is ultimately responsible for securing changes, a plan should designate who is in charge of the individual policy changes and deadlines for those to take place. Providers can use pre-PHE policies to guide them when needed, Markette suggests.

The plan also needs to set clear deadlines. “Make sure everyone involved understands that the deadline is a concrete deadline set by law,” Markette stresses.

Step 5: Train Staff

Begin educating staff on the new policies, making sure to shoot for compliance before the PHE expires, Markette recommends.

Keep in mind: Your staff have had two years to get into the habit of waiver-allowed policies. It may take time to get them compliant with the old requirements, especially when they add burden.

Step 6: Audit to Verify You’re on Track

Audit to confirm compliance with post-PHE procedures, then provide follow-up training based on the errors found, Markette advises. That training can be for all affected staff or for individuals, based on the pattern of errors detected.

Step 7: Boost Infection Control Protocol

Chances are that staff members will encounter more patients and family members whose vaccinations are not up to date and who may have symptoms but have not been tested. Practices should step up precautionary measures, and staff should be more vigilant about their safety after the pandemic officially ends.

Urgent: “Providers should not wait until the last minute to undo PHE processes,” urge attorneys Gary A. Rosenberg and Victoria Larson with law firm Verrill. “Post-PHE operations will lack many of the waivers and flexibilities providers have grown accustomed to during the pandemic,” Rosenberg and Larson say in an online analysis. “To avoid fraud violations, providers will need to be prepared to adapt their practices,” they stress.