From March 24-26, 2021, the American Health Law Association (AHLA) hosted a Virtual Institute on Medicare and Medicaid Payment Issues. The program addresses legal and regulatory issues related to reimbursement and brings together a variety of stakeholders from private practice and key government health care regulators, including representatives from the Centers for Medicare and Medicaid Services (CMS ), the Health and Human Services Office of Inspector General (HHS-OIG), and the Department of Justice (DOJ). Government stakeholders often provide valuable insight into what the industry as a whole and suppliers can expect in a post-pandemic world and with a new administration.
As expected, the COVID-19 public health emergency was at the heart of many presentations. Below are two key takeaways from the conference.
COVID-19 compliance audits are on the horizon
Through the CARES (Coronavirus Aid, Relief, and Economic Security Act), qualified healthcare, service, and support providers received various relief payments to cover healthcare-related expenses or loss of income during the public health emergency. Suppliers who comply with all terms and conditions are not required to refund any funds received. However, suppliers who provide inaccurate information may be subject to recovery and other legal action, or in the event of willful misconduct, suppliers may face criminal, civil or administrative penalties, revocation of Medicare billing privileges, excluding or subject to the False Claims Act. The OIG has identified provider relief payments as a priority area of its work plan, including HHS’s calculation of provider relief payments and their distribution to eligible providers, quarterly information and reporting, and compliance. providers of post-payment notification requirements. In addition, the Office of Management and Budget (OMB) will conduct audits of business entities that have received $750,000 or more in federal funding in a single fiscal year. Accordingly, providers should familiarize themselves with all FAQs and maintain detailed and accurate documentation of all provider relief funds.
Telehealth is here to stay
One of the results of the COVID pandemic has been expanded access to telehealth. The Coronavirus Preparedness and Response Supplementary Appropriations Act (CPRSAA) and CARES Act have provided numerous allocations to expand telehealth in immediate response to the public health emergency. Due in part to the success of telehealth in meeting the needs of the public, Medicare’s Physician Fee Schedule for CY 2021 demonstrates that the expansion of telehealth will continue beyond the pandemic. For example, new services have been added to Medicare’s telehealth roster, and permanent additions include home visits and custodial care, cognitive assessments and care planning, and group psychotherapy visits. Temporary additions include all levels of physical and occupational therapy, nursing facility discharge visits and emergency room visits, among others. As with all government programs, with expansion, telehealth and telefraud have become the focus of increased enforcement activity and telehealth providers should expect to come under increased scrutiny from CMS/OIG. .
What suppliers can expect from the Biden administration
The new administration is expected to focus on increasing COVID-19 relief and stimulus payments and restoring and expanding the Affordable Care Act (ACA). Biden’s COVID aid will focus on expanding vaccine funding and distribution, testing, treatment, and increasing funding for rural healthcare providers. When it comes to the ACA, the Biden administration is seeking to reverse many state waivers allowed under the Trump administration. For example, Biden signed an executive order ordering the agency’s review and expressed to various states his intention to revoke waivers that Medicaid beneficiaries work as a condition of coverage.