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No Surprises Act and You (Published in the SCMS Winter 2022 Newsletter)

Legislation has been adopted by the United States Congress and the Ohio Legislature known as the “No Surprises Act” which attempts to regulate billing by professionals and facilities to patients who are not in networks with those facilities or providers at those facilities. The federal bill was triggered by some sensational news stories of patients being billed for tens of thousands of dollars for emergency care when the hospital was out of the network under the patient’s insurance plans.

Wondering What’s Happening with Telehealth Legislation in Ohio?

In December 2021, Governor DeWine signed into law HB 122, which will expand telehealth services in Ohio. The law takes effect in March 2022 and is in response to more patients relying on telehealth over the past two years during the height of the COVID pandemic, and more providers becoming comfortable with delivering services virtually. Telehealth is now a normalized healthcare delivery system nationwide. Beyond the safety benefits inherent in telehealth services, telehealth has made healthcare more accessible and more affordable for more people.

Important Updates Every Provider Should Know: Information Blocking

In December 2016, Congress passed the 21st Century Cures Act (“Cures Act”) which: (1) authorized funding for the National Institutes of Health to promote medical research and drug development, (2) implemented provisions aimed at addressing the prevention and treatment of mental illness and substance abuse, and (3) reformed certain standards of the Medicare program and federal tax laws to foster healthcare access and quality improvement.

HHS Announces an Additional $20 Billion In Provider Relief Grants

The U.S. Department of Health and Human Services (“HHS”) announced an additional $20 billion in new funding for providers on October 1, 2020. Eligible providers include those that have already received Provider Relief Fund payments as well as previously ineligible providers, such as those who began practicing in 2020, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic. The new Phase 3 General Distribution is designed to balance an equitable payment of 2% of annual revenue from patient care for all applicants plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.

Provider Relief Fund Phase 2 & Reporting Requirement Updates – Deadline to Request Phase 2 Funds is August 28, 2020

On July 31, 2020, the Department of Health and Human Services (“HHS”) announced that certain Medicare, Medicaid (managed care and fee-for-service), CHIP, and other providers would be given another opportunity to receive additional Provider Relief Fund payments. HHS has allocated around $15 billion for Phase 2 distribution. Providers are eligible for these new distributions if they fulfill the following criteria and have not yet received a Provider Fund payment equal to approximately 2% of their revenue from patient care.

Webinar Recording: Telemedicine Legal and Practical Considerations for Physicians Practices

This webinar discusses the latest developments in telemedicine for physician practices, including Medicare, Medicaid and commercial payor reimbursement requirements, state licensure considerations and HIPAA requirements. Speakers: -Kyle Sharp, MHA, FACHE, Interim Associate VP & Executive Director, OSU Physicians, Inc. -Ronnen Isakov, CPA, Managing Director, Healthcare Advisory Services, Medic Management Group LLC -Kate Hickner, Healthcare & Hospital Law Partner, BMD -Kevin Cripe, Healthcare & Hospital Law Attorney, BMD The speakers will share their personal experiences working with health care providers to implement and grow their telemedicine practices during recent months. The webinar will provide listeners with practical guidance and take-aways that will be useful in their own organizations.

President Trump Signs Executive Orders that Enable Access to Affordable Meds

On Friday, July 24, 2020, President Trump signed four Executive Orders concerning prescription drug pricing which collectively direct the Secretary of the Department of Health and Human Services (HHS) to take following actions: 1. Increase Patient Access to Insulin and Injectable Epinephrine 2. Facilitate the Importation of Certain Prescription Drugs 3. Remove the Anti-Kickback Safe Harbor Protection for Prescription Rebates 4. Implement the “Most Favored Nation” Order to Lower Medicare Part B Drug Cost

DOJ Updates Corporate Compliance Plan Guidance

With the passage of the Affordable Care Act in 2010, all healthcare providers were required to adopt and implement a corporate compliance plan. Historically, having an effective corporate compliance plan in place has been key to defending healthcare providers in fraud and abuse actions by Medicare, Medicaid, and commercial payers. Over the past couple of years, the U.S. Department of Justice’s (DOJ) Criminal Division has increased the number of prosecutions against U.S. corporations, including healthcare providers. Earlier this month, the DOJ’s Criminal Division updated its “Evaluation of Corporate Compliance Programs” guidance to educate prosecutors on how a corporate compliance program will be evaluated going forward.

Important Updates, Deadlines, and Clarifications for the HHS Provider Relief Funds

On May 20, 2020, HHS made important updates and clarifications regarding the General Distribution payments to providers. Between April 10, 2020 and April 24, 2020, HHS distributed an initial $30 billion to providers based on the provider’s 2019 Medicare fee-for-service receipts. These funds were distributed automatically and providers did not need to submit an application in order to receive these funds. The funds were originally touted as a “no strings attached” stimulus payment reserved for healthcare providers. But HHS issued a 10-page Terms and Conditions and required that providers sign an attestation confirming receipt of the funds and agreeing to the Terms and Conditions.

Healthcare Providers: Comparison of New OIG Waivers and Flexibilities under Anti-Kickback Statute in Response to COVID-19

On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued several temporary regulatory waivers to further enable the American healthcare system to respond to the COVID-19 pandemic with more efficiency and flexibility (the “Blanket Waivers”).

COVID-19 and Telehealth for Ohio and Florida

Over the last week, private insurers as well as federal and state healthcare programs have continued to issue updates to the provision of telehealth. In order to increase availability of appointments for a wide variety of services while also keeping patients and providers safe, many payors have expanded their telehealth offerings.

BMD COVID-19 Healthcare Provider Resource Guide

Providers - for the latest information related to Medicaid/Medicare, Telehealth, HIPAA, CPT Codes, as well as Ohio and Federal Information, click here for a comprehensive resource guide to navigating during the Coronavirus pandemic.

CLIENT ALERT: Proposed New Rules to both the Stark Law and the Anti-Kickback Statute

On October 9, 2019, as part of the “Regulatory Sprint to Coordinate Care,” the Centers for Medicare and Medicaid Services (“CMS”), along with the US Department of Health and Human Services, Office of Inspector General (“OIG”), proposed new rules to both the physician self-referral law (“Stark Law”) and the Anti-Kickback Statute (“AKS”). Rule changes are aimed at fostering innovative arrangements for coordinating care consistent with a shift to a value-based system. Both proposed rules are expected to be published to the Federal Register on October 17, 2019. Public comments are due 75 days after publication.

CLIENT ALERT: Medicare Providers having multiple locations should verify and revalidate their address information to avoid claim denials

MLN Matters SE19007 “Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations” notifies providers that Medicare is now requiring the exact match of all addresses for practice locations that are listed on provider claim submissions to Medicare.

The Massive Medicare Appeals Backlog is Significantly Harming Providers, What You Can Do To Stop It

Few occurrences in healthcare billing and coding will bring instant anxiety as receiving an overpayment demand from one of CMS’ contractors. We all know that we are lucky if we make it through the first two levels of appeal (Redetermination-Level 1 and Reconsideration-Level 2) with 100% success on all claims, even if every claim was billed correctly.