Monthly Newsletter

January 2021

Monthly Newsletter

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A Payer Audit- During a Pandemic?  Really?

Can a fair and reasonable audit be conducted during the COVID-19 pandemic? What are you rights as a provider?

How to respond to a request for information (RFI) during the COVID pandemic is addressed in the most recent AIHC Blog article “An Audit Now What? How to Request a Fair and Reasonable Process during a Pandemic”.





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First National Strategic Plan to Address Sexually Transmitted Infections

The current rise of STIs is a serious public health concern that requires immediate attention. If left untreated, STIs can lead to severe health complications, including pelvic inflammatory disease (PID), increased risk of getting HIV, certain cancers, and even infertility, as reported by Health & Human Services (HHS).  HHS is releasing the first-ever national plan to address the public health crisis caused by alarming increases in rates of sexually transmitted infections (STIs) in the United States over the past six years. 


The STI National Strategic PlanThe 2021-2025 STI Plan sets national goals, objectives, and strategies to respond to the STI epidemic. The plan will serve as a roadmap to help federal and non-federal stakeholders at all levels and in all sectors reverse the sharp upward trends in STI rates.


Impact of SDoH - Social determinants of health contribute to a substantial unequal burden of STIs in Black, American Indian/Alaska Native and Hispanic communities. In addition, people living in the Southern and Western regions of the U.S. are disproportionately affected.


Recent data show that rates of sexually transmitted infections (STIs) reached an all-time high in 2018 among both females and males, and all racial and ethnic groups. According to the Centers for Disease Control and Prevention (CDC), the number of combined cases of gonorrhea, syphilis and chlamydia was more than 2.4 million in 2018, up from 1.8 million in 2013; half of these STIs are among youth. While these STI have increased considerably over the past five years, human papillomavirus (HPV) remains the most commonly sexually transmitted infection in the United States, with 79 million Americans infected, most in their late teens and early 20s.  Click Here for the STI Plan Visions & Goals.



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HIPAA Right of Access Violation - OCR Reports on 13th Investigation

What is a “Right of Access Violation”?

The Office for Civil Rights (OCR) created the Right of Access Initiative to address the many instances where patients have not been given timely access to their medical records.  Health care providers, large and small, must ensure that individuals get timely access to their health records, and for a reasonable cost-based fee. Right of Access falls under the HIPAA rule. OCR is the government enforcement agency for HIPAA. 


Since the launch of the Right of Access Initiative in late 2019, OCR has investigated and settled 13 cases.  The most recent case settled is with Peter Wrobel, M.D., P.C., doing business as Elite Primary Care ("Elite") in Georgia.  Two complaints were filed with OCR regarding Elite’s lack of response to access of medical records.  OCR initiated an investigation and determined that Elite's failure to provide the requested medical records was a potential violation of the HIPAA right of access standard. This cost Elite $36,000 to settle the potential violation of the HIPAA Privacy Rules’ Right of Access Standard as well as taking Corrective Action. Click Here to view the Resolution Agreement.  Learn more about HIPAA Privacy & Security.




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Sequestration Suspended Until March 31, 2021

The Centers for Medicare & Medicaid Services (CMS) announced on December 28, 2020 that the 2% payment Adjustment or Sequestration, is suspended through March 2021.  The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021 and applies to all Medicare Fee-For-Service claims since May 1, 2020.



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COVID, Stress, Workplace Violence and Healthcare 

Watch the 2-part series on Workplace Violence free on the AIHC YouTube channel under our Human Resources Playlist! These educational videos were featured during the December Compliance Resource Week. 



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COVID-19 PHE & FAQ of OIG's

The Office of Inspector General (OIG) updated the Frequently Asked Questions related to how the OIG’s application of administrative enforcement to arrangements directly connected with the COVID-19 Public Health Emergency (PHE) in December, 2020. Click Here for the FAQ page on the OIG website.


If you have a question regarding how OIG would view an arrangement that is directly connected to the PHE, please submit your question to OIGComplianceSuggestions@oig.hhs.gov. In your submission, please provide sufficient facts to allow for an understanding of the key parties and terms of the arrangement at issue. The OIG will update the FAQ site as they respond to additional frequently asked questions.

 



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COVID: Infection Control Guidance for Healthcare Professionals

The Flu, Pneumonia, COVID and the common cold are just a few reasons to ensure we are protecting our workforce and patients.  COVID-19 is caused by the SARS-CoV-2 infection and it is vital that health care professionals pay close attention to consistent good infection control practices.


On December 14, 2020 the Centers for Disease Control (CDC) has a Summary of Recent Changes to the Infection Control Guidance specifically for U.S. setting where healthcare is delivered.  The CDC has added links to FAQ addressing Environmental Cleaning and Disinfection and to assessing risks to patient and others exposed to healthcare personnel who worked while infected with SARS-CoV-2.  Read more and view previous updates.  Click Here for the health care worker’s Infection Control Resource Page on the CDC website.



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Telehealth Today: Challenges & Opportunities

Perhaps the main benefit of telehealth is that it allows providers to establish contact and keep in touch with patients that might otherwise be difficult to reach. Busy front-line workers, patients who are geographically remote, or even discharged patients following hospital stays all become more accessible. This is a tremendous opportunity for healthcare facilities to broaden their impact. However, addressing the associated challenges which accompany these opportunities should not be ignored . . .  read more

Expansion of telehealth services CMS press release related to the 2021 Physician Fee Schedule Final Rule (scroll down for more information on this topic).




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January 1, 2021 Starts Hospital Price Transparency Monitoring

Is your institution prepared to comply with the requirements of the Hospital Price Transparency Final Rule?

 

CMS  Audits

CMS plans to audit a sample of hospitals for compliance starting in January, in addition to investigating complaints submitted to CMS and reviewing analyses of non-compliance, and hospitals may face civil monetary penalties for noncompliance.  See 45 CFR part 180 Subpart C- Monitoring and Penalties for Noncompliance.


How to Comply

Effective January 1, 2021, each hospital operating in the United States is required to provide publicly accessible standard charge information online about the items and services they provide in 2 ways:

  1. Comprehensive machine-readable file with all items and services
  2. Display of 300 shoppable services in a consumer-friendly format

Click Here for the Federal Register - Final Rule and visit the Hospital Price Transparency website for additional information and resources to help hospitals prepare for compliance, including:

Implement an internal business system auditing program – learn how with online, on-demand training with option to certify as a Healthcare Auditor or Internal Investigator.



Revised Preventive Services Educational Tool

Medicare has revised the Learning Network Educational Tool for Medicare Preventive Services.  This tool addresses Coding, Coverage, Copayment/Coinsurance and deductible information.  To access the tool – Click Here. Download and print the Preventive Services Poster. Also access the Medicare Wellness Visits and COVID-19 Vaccines and Monoclonal Antibodies information page on the National CMS website and the latest from the American Medical Association (AMA) on CPT codes for new coronavirus vaccines – What You Need to Know.




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MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline for COVID-19 has been Extended to February 1, 2021

CMS has extended the deadline for COVID-19 related 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception applications to February 1, 2021.


For the 2020 performance year, CMS will be using our Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency.


Concerns?

Submit an application NOW if you have any concerns about the effect of the COVID-19 public health emergency on your performance data, including cost measures, for the 2020 performance period.  Be sure to cite COVID-19 as the reason for your application.  Click Here to submit an application now.


If you submit an application for either of the exceptions, you will be notified by email if your request was approved or denied. If approved, this will also be added to your eligibility profile on the QPP Participation Status Tool, but may not appear in the tool until the submission window is open in 2021.


For assistance, we recommend reviewing the CMS step by step video and  Download the Guide that walks you through how to submit the application. Also, visit the Extreme and Uncontrollable Circumstances Exception QPP webpage for more information and link to the application and check out the Download the Exceptions Application Fact Sheet to learn more about these exceptions.



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January 1, 2021 & the Medicare Physician Fee Schedule (PFS) 

The PFS Final rule updates policies affecting the calculation of payment rates and includes mis-valued codes. It also adds services to the telehealth list including a third temporary category for services added under the Public Health Emergency (PHE) as well as certain other revisions to telehealth services. 


The Final Rule also addresses direct supervision as it relates to interactive technology, payment for teaching physicians, and provides clarification on medical record documentation. It also includes several regulatory actions regarding professional scope of practice for certain non-physician practitioners. This final rule also provides clarification to the implementation of Section 2005 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which creates a new Medicare Part B benefit for Opioid Treatment Programs. The calendar year (CY) 2021 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.


For more information regarding the Final Rule, please reference the following resources:



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