What is on the horizon in Revenue Cycle Management?
Our in-house Compliance Officer K.D. Pakootas explores the hot topic that many healthcare businesses need to address before it is too late. Ask yourself, is your physician practice, laboratory, surgical center or medical clinic fully prepared to cope with the imminent changes to medical billing and coding regulations? Unsure? Worry not, read on to ensure you are ready for the post-COVID chapter.
COVID Emergency Blanket Waivers
The Center for Medicare & Medicaid (CMS) has provided emergency blanket waivers and flexibilities throughout the public health emergency. Applauded by the industry, the measures give healthcare providers the ability to address the prevention, diagnosis, and treatment of COVID-19 without the burden of navigating the intricacies of compliance. In essence, to combat the waves of COVID, CMS threw the healthcare industry, several life preservers. As vaccines successfully roll out across the country, a return to a ‘new normal’ seems achievable. Quite rightly, conversations now shift to looking further ahead, specifically, what happens when the public health emergency expires?
“The Administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the Administration’s aggressive efforts against COVID-19. As a result, the following blanket waivers are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration.”
Statement from CMS updated June 24, 2021. For full details of blanket waivers, visit CMS website
Compliance Planning for The Year Ahead
Within healthcare compliance, as professionals, we look to the Office of Inspector General (OIG). As many in the healthcare industry already know, the organization publishes work plans with monthly updates. Contents include current OIG audits and evaluations and those planned for the fiscal year. As you would expect, 2020 was an unprecedented year overshadowed by the pandemic; many COVID-related issues are under review in the 2021 Work Plan. It is no surprise that focus points include various telehealth services, the Coronavirus Aid, Relief and Economic Security (CARES) Act, and other laboratory testing and billing concerns.
Our Post-COVID Compliance Advice for Healthcare Providers and Businesses
- Identify all Emergency waivers and allowances applicable to your practice and review the understanding and application to your entity.
- Adapt internal auditing and monitoring processes to include documentation and billing requirements of waivers granted throughout the pandemic.
- Review processes implemented during the pandemic to ensure compliance was achieved during implementation
- For errors or weaknesses identified by internal reviews, implement corrections and adapt corresponding processes to resolve any issues.
“As the saying goes, ‘Fail to prepare. Prepare to fail’. Many in the healthcare industry were caught unawares by the COVID-19 pandemic and spent the last 18 months struggling to keep up. Don’t let this happen again. Ensure your physician practice, medical clinic, surgical center, or laboratory is properly informed and well-armed for the next phase.”
K.D. Pakootas, AIMA Compliance Officer
