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Healthcare Providers Take Notice: AMA Updates E/M Codes for 2021

In addition to staying up to date on the constantly changing landscape of COVID-19 requirements, healthcare providers must also stay well-informed of industry changes unrelated to the pandemic. On January 1, 2021, changes in Evaluation and Management (‘E/M’) codes for physicians took effect. These changes, proposed by the Centers for Medicare & Medicaid Services (‘CMS’), primarily impact 2021 Medicare Physician Fee Schedule (‘MPFS’) reimbursements. More >

The 2020 CARES Act: Caring About Substance Abuse Treatment Document ("SUD") Privacy

As of March 8th, 2021 there were more than 28,813,424 cases and 523,850 COVID-19-related deaths in the U.S., representing 20% of the world's known COVID-19 deaths, and the most deaths of any country.[1] More >

A Christmas Miracle! Congress Agrees on a New Coronavirus Relief Bill

After nine months of negotiations and stalemates, Congress finally reached an agreement for a $900 billion relief package on December 20, 2020. Included are many familiar provisions from the March CARES Act, with a particular emphasis on small business benefits and relief for health care providers. More >

Malnutrition Diagnosis Codes: The Compliance Danger You’re Not Taking Seriously Enough

It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake. The estimated overpayment as a result of these coding errors is a reported $1 billion. Because the payment error rate was so high at a colossal 31%, Medicare-Severity Diagnosis Related Group ("MS-DRG") applicable entities must take note and prepare for a marked increase in Department of Health and Human Services Office of Inspector General ("OIG") audits for these coding practices. The Centers for Medicare & Medicaid Services ("CMS") also plans to implement review practices for malnutrition coding on a sample of inpatient claims. The increased payer audits will result in severe financial damage for hospitals and other MS-DRG applicable entities if they do not mitigate coding and documentation risks. More >

Alert: Rural Health Clinics - Your COVID-19 Testing Program Report is Due NOW!

While the extra health care dollars distributed by HHS for coronavirus testing were well received by rural health clinics and other providers, those funds come with important reporting requirements that take effect immediately.  The Department of Health and Human Services’ funding initiative of $225 million for rural health clinics’ coronavirus testing efforts, known as the Rural Testing Relief Fund or Rural Health Clinic (“RHC”) COVID-19 Testing Program, is no exception to such requirements. These reporting requirements as well as the others for state and federal health care dollars related to the pandemic should be carefully followed as the HHS Inspector General and the Department of Justice are already investigating to ferret out misuse, fraud, waste, and abuse of these funds.   More >

WARNING: DOL Moves the Goalposts on FFCRA for Healthcare Providers

When the Families First Coronavirus Response Act (“FFCRA”) was passed, healthcare providers breathed a sigh of relief to see that an exception had been carved out for them regarding the mandatory leave provisions of the law. This exclusion permitted entities with less than 500 employees to exclude “health care providers” from mandatory leave provisions. The first rules to interpret this provision defined “health care providers” in such a manner that all employees of a healthcare provider that itself met the definition would also meet the exclusion. This interpretation is no more. More >

A Potpourri of COVID-19 Takeaways for Healthcare Providers

While the COVID-19 virus surges and possibly re-surges in states all around us, Kentucky’s cautious management of this crisis has created opportunities for healthcare providers to ease back into business and shift into recovery. Whether Kentucky can continue to contain the virus is uncertain, but as healthcare providers retool and spend the federal dollars infused by the CARES ACT, here are the areas to watch. More >

Reimbursement Relief for Healthcare Providers Treating the Uninsured

Reimbursement relief is on the way for healthcare providers who have conducted COVID-19 testing or provided treatment for COVID-19 individuals who are uninsured. The COVID-19 Uninsured Program Portal allows for providers to submit claims for reimbursement beginning May 6, 2020 for COVID -19 services on or after February 4, 2020. These reimbursements will be made at Medicare rates. More >

FCC is awarding funds for the COVID-19 Telehealth Program

The Coronavirus Aid, Relief, and Economic Security (CARES) Act that was passed into law in March 2020 set aside $200 million in funds for the Federal Communications Commission (FCC) to establish the COVID-19 Telehealth Program. The program’s intent is to keep physicians and patients safe while continuing care remotely. The support provided through telehealth is intended for treatment of both coronavirus and other ongoing health conditions during the pandemic. More >

DOJ’s Nursing Home Initiative Targets Providers – Compliance Will Be Critical!

A new initiative announced by the Department of Justice (DOJ) on March 3, 2020, is aimed at investigating “grossly substandard care” in nursing homes. The National Nursing Home Initiative will initially be targeting the nation’s most problematic facilities and will use both civil and criminal enforcement actions where these facilities are putting the health and safety of residents in danger. The initiative serves as one focus in the DOJ’s larger efforts in protecting the elderly and is coordinated by the Elder Justice Initiative. More >

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