Navigating Compliance During COVID-19

In response to the COVID-19 public health emergency, many hospitals and providers are having to approach care differently. This shift in the delivery of care has also resulted in a shift in how Compliance Departments advise providers and other departments, such as billing and coding, to be compliant with federal and state regulations and guidance. State and federal agencies, such as the Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS) Office of Inspector General (OIG), and Office for Civil Rights (OCR) have loosened requirements, enacted waivers, and issued notices of enforcement discretion during the public health emergency. These loosened requirements have come out at a rapid pace and are sometimes unclear and inconsistently interpreted by contractors.

However, there have been a few consistent themes across guidance materials and published regulations. Both CMS and OCR have significantly lifted restrictions on telehealth and telemedicine services. Medicare regulations used to limit telehealth by geographic region, originating site, and service provided. Many of these restrictions have now been loosened or waived to decrease the need for patients and providers to risk exposure to, or spread of, the novel coronavirus. Additionally, OCR, the agency responsible for enforcing the Health Insurance Portability and Accountability Act of 1996 (HIPAA), announced that it would use its enforcement discretion to loosen restrictions on the use of certain telecommunication technology for telehealth services. Also, many states have announced relaxing of licensure requirements for retired physicians and advanced practitioners, allowing such providers to help with the influx of patients. In addition, CMS has announced significant waivers for swing-bed requirements in an effort to decrease transmission to other hospital units or long-term care facilities.

Most EMTALA requirements, however, are still in place, and will be enforced in an effort to ensure proper screening of patients presenting at emergency room locations and to deter inappropriate transfers of possible COVID-19 patients.

A few steps that Compliance Officers can take to respond to these changes in a meaningful way include the following:

  1. Tracking important dates for changes in policy, guidance, and regulations for internal and external audit purposes;
  2. Tracking all state and federal alerts to keep abreast of changes of policy;
  3. Communicate with Medicare Administrative Contractors (MAC) to ensure understanding of new policy changes and use CMS email contacts for clarification on guidance materials;
  4. Developing a plan for what happens when the public health emergency ends (i.e., how to transition back to status quo), including processes for monitoring and auditing areas of risk that have emerged for your organization;
  5. Applying federal waivers appropriately (many of them make concessions where there are additional requirements imposed by the state); and
  6. Keeping state and federal agencies’ COVID-19 information on a single webpage to ensure the information is readily available.

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For more information on this subject, contact Alexis Rose, JD at [email protected].