Healthcare Law Blog

Pandemic Pivot to Telemedicine Creates New Compliance Issues for Healthcare Providers

The shift to telemedicine in the United States predates the pandemic, but COVID-19 has accelerated its widespread use. In April of 2019, the Centers of Medicare and Medicaid Service (CMS) finalized rules to increase telehealth benefits for Medicare Advantage enrollees, effectively incentivizing health systems with high numbers of private Medicare plan recipients to invest in telehealth services. 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 >

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 >

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 >

Kentucky Sets Detailed Timeline for Phased Reopening of Healthcare Providers

The Kentucky Department for Public Health (KDPH) has released a four-stage plan for reopening Kentucky’s health care services in the wake of the COVID-19 pandemic with the first phase beginning on April 27, 2020, and the fourth and final stage being implemented on May 27, 2020. The intention is to gradually loosen restrictions on services while providing requirements that must be met in order to mitigate against the COVID-19 pandemic.  More >

CMS Expands Accelerated and Advance Payment Program for COVID-19 Emergency

As part of the CARES Act, the Centers for Medicare & Medicaid Services (CMS) has expanded the Accelerated and Advance Payment Program to a larger group of Part A providers and Part B suppliers. The full fact sheet on the expansion is available from CMS here, but we’ve summarized the significant points below. More >

Kentucky Board of Nursing Issues Advisory on Nurse Practitioner Prescribing During State of Emergency, Pushes Telehealth

Getting Long-Term Lost with Compliance for Long Term Care? OIG Has A Roadmap

Long Term Care (“LTC”) facilities have been a renewed area of focus for regulators in recent years, due to changes in Medicare and the potential for harm to a vulnerable population at the hands of bad actors. In April of 2019, for instance, the U.S. Department of Health & Human Services Office of Inspector General (“OIG”) put out a Data Brief with the ominous headline, “Trends in Deficiencies at Nursing Homes Show That Improvements Are Needed To Ensure the Health and Safety of Residents.” Unfortunately, this renewed focus exponentially increases the need for a push to instill compliance as a key tenet of a facility’s culture. Luckily, in 2000 and again in 2008, the OIG released a very clear roadmap for compliance that’s still reliable today. We’ll hit some of the highlights. More >