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JULY 2020

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August 2020
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June 2020

New Office Burden Reduction & Health Informatics

On June 23, 2020 CMS announced a new office created to help reduce burden on our health care system, the creation of the Office of Burden Reduction & Health Informatics.   It is an extension of the “Patients over Paperwork Initiative” or PoP, to cut the red tape of an already overburdened health care system.


CMS has heard from over 2,500 providers, clinicians, administrative staff, health care leaders, beneficiaries and their support teams through 158 site visits and listening sessions. The results are expected to save providers and clinicians $6.6 billion and 42 million unnecessary burden hours through 2021. Click Here to read more from the CMS Newsroom.


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COVID-19 UPDATES

COVID-19 Testing for Nursing Home Residents and Patients

The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare Administrative Contactors and notified Medicare Advantage plans in June 2020 to cover coronavirus disease 2019 (COVID-19) laboratory tests for nursing home residents and patients.

Medicare Advantage plans must continue not to charge cost sharing (including deductibles, copayments, and coinsurance) or apply prior authorization or other utilization management requirements for COVID-19 tests and testing-related services.  In addition, CMS has instructed Medicare Administrative Contactors to cover coronavirus disease 2019 (COVID-19) laboratory tests for nursing home residents and patients. 

Click Here for the MLN SE20011 Revised Article updated June 2020 for more information. The testing Guidelines for Nursing Homes has been updated by the Centers for Disease Control (CDC) – click here for more information on testing.  Click Here for current CDC Novel Coronavirus Reports.


AMA announces CPT codes for antigen tests in the fight against COVID-19

The American Medical Association (AMA) announced an update to Current Procedural Terminology (CPT®) that includes a new code for reporting antigen testing of patients suspected of being infected with the novel coronavirus (SARS-CoV-2) on June 25, 2020 as follows:

  • 87426 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
  • 87635  Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
  • 86328    Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
  • 86769  Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Click Here for more information


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COVID-19 Fraud Alert

Potential Fraud & Abuse with COVID-19 Add-on Testing
CMS has relaxed rules related to COVID-19 testing and other associated diagnostic laboratory testing resulting in no longer requiring an order during the COVID-19 public health emergency. Beyond the COVID-19 tests, laboratories can now also perform add-on tests, for example to confirm or rule out diagnosis other than COVID-19. However, the Office of Inspector General (OIG) has program integrity concerns related to add-on tests in conjunction with COVID-19 testing, particularly related to potentially fraudulent billing for associated respiratory pathogen panel (RPP) tests, allergy tests, or genetic tests.  This concern has resulted in updating the OIG Work Plan to perform Trend Analysis of Medicare Laboratory Billing for Potential Fraud & Abuse with COVID-19 Add-on Testing.   Click Here to read more.


OIG Video “5 things About COVID-19 Fraud” produced for beneficiaries – share this important information with your patients and billing staff.


COVID-19 Telehealth resources for Providers

During the COVID-19 public health emergency, clinicians can use telehealth and remote communication technologies that may not be fully HIPAA compliant — such as FaceTime, Facebook Messenger, Google Hangouts, Zoom, or Skype — without being penalized for noncompliance with HIPAA rules related to the good faith provision of telehealth.


For details about this, see the Notification of Enforcement Discretion issued by the HHS Office for Civil Rights (OCR) and also read the Office of Civil Rights (OCR) FAQs on Telehealth and HIPAA.  Click Here for the Telehealth Government Providers Page and attend the HIPAA Compliance Event in Las Vegas April 28-29, 2021 or train online.


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Understanding Hospital Utilization During COVID-19

Using Medicare claims data, the OIG will analyze the effects of COVID-19 on hospitalized Medicare beneficiaries and the hospital resources needed to care for them. Specifically, it will review utilization of the treatments provided and paid for by Medicare for patients with COVID-19 in selected localities that have known outbreaks. It will also describe the extent to which hospital utilization for Medicare beneficiaries changed over time.  


This is a new item added to the OIG Work Plan – Click Here for more.



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Crime Doesn't Pay

Physician Charged with $630,000 SBA COVID-19 Loan Fraud

Providers with pending criminal charges are ineligible for COVID-19 Payment Protection Program (PPP) relief under the SBA (Small Business Administration).  However, in April 2020 Dr. Ameet Goyal, an Ophthalmologist in New York fraudulently obtained these guaranteed loans while on pretrial release. Due to misrepresentations made during the application process, Dr.  Goyal successfully obtained two PPP loans totaling over $630,000.


Click Here for the rest of this story.


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$2.625M to settle False Claims Act Investigation against August  University Medical Center

Augusta University Medical Center, Inc. (AUMC) violated the False Claims Act by knowingly submitting claims to federal healthcare programs for a procedure that was not covered by Medicare and Medicaid. The investigation involved these medically unreasonable and unnecessary “procedures,” referred to as a “Belsey Collis” were billed as a covered procedure, as well as post-surgical follow-up care. Click Here for the rest of this story.



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Drug Screening Lad Owner Pays $9 Million for Fraud

American Toxicology Labs (ATL) owner and his wife plead guilty to health care fraud charges.  ATL conducted urine screening tests for various entities who represented themselves as opioid treatment facilities.  Click Here for the full story.



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Earn 0.5 Ethics CEUs from this Newsletter!


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