APDA News & Covid-19 Updates August 2020 |
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Topics for today's Newsletter
- Federal Register publishes 2021 Proposed rule 6% cut to PXR
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ALERT!..fraudulent postcards sent to healthcare providers disguised as government communication - requests immediate HIPAA assessment.
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MACs are resuming post payment medical reviews on August 17, 2020
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HHS calls for congressional action to stop surprise patient billing-targeting out of network providers
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Reminder to Members- encrypt PHI on all mobile devices. Facility pays $1,040,000 to OCR for employee stolen laptop.
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HHS Extends Application Deadline for Medicaid Providers and Plans to Reopen Portal to Certain Medicare Providers to apply for additional funds
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CMS extends deadline to use new ABN form to January 2021
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During public health emergency, CMS will not issue new revalidation notices
- Republican stimulus bill will likely include liability reform
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APDA is working for you and the Portable Diagnostic Industry.....
Membership in APDA proves to be one of the most valuable tools for Portable Diagnostic Providers. Members (especially new members) agree that APDA's networking and continuous stream of industry information has become an essential part of their business. The most typical comment made by new members is "what did I ever do without APDA-I have learned so much already"
APDA is constantly working for its members. The Executive committee participates in 2-3 calls per week meeting with consultants, CMS, industry stakeholders and others as they push for fair recognition, policies and reimbursement for you and all portable diagnositc providers. Hours of data research, creation of spreadsheets, number crunching, and letter writing are just some of the work being done by officers of the Executive Committee on behalf of APDA members.
As of today,
- Rcode cuts to 11 states are on hold
- Discussions have taken place with CMS about the possibility of exemption from consolidated billing
- Additional Covid-19 reimbursement has been discussed with CMS
- Work is in place to present a comment against the 6% PXR cut in the 2021 proposed rule
You can count on APDA to listen to you and advocate for your business and the industry. If you have questions or concerns, the executive committee officers or board members would truly like to hear from you. Please call or email them for questions about policies, billing, industry issues, APDA activity updates, or whatever is on your mind. We are always working on ways to better serve our members. Please let us know how we can help you.
APDA adds a NEWS SECTION to its Website Home Page. Here you will find the latest APDA news and activities-such as APDA projects, initiatives and activity updates. We will also share with readers updates on billing, regulations, Medicare news, and more. We encourage members and industry partners to visit our website daily for important news and updates.
Due to Covid 19, APDA has decided to create a Fantastic Virtual Fall Conference. Stay tuned for more information.
The APDA conference committee is diligently working on behalf of its members and industry partners in an effort to bring everyone a most unique and informative conference. If you have any questions email us at: membership@apdahealth.com
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CMS Publishes 2021 proposed Final rule - including a 6% across the board cut to Portable X-ray
APDA executive committee is deligently crafting a comment (due October 5, 2020) against the proposed cuts. It is unquestionable that these cuts MUST be halted - especially considering the Covid 19 financial burden providers have had to deal with (where the burden of cost has been placed on the PXR providers - with no relief funds as given to Nursing Homes for testing, ppe,etc.)
Your input, comments and stories on how these cuts will affect your business are very important to our executive committee and Cornerstone as they work on our Final Rule comment. Please send your comments to the executive committee. Please read the final rule- click on attached link - see page 899.
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ALERT: POSTCARD DISGUISED AS OFFICIAL OCR COMMUNICATION 8/6/2020
As published on NGS News and Alerts ..."National Government Services would like to make providers aware of an official notification sent out by the OCR regarding a mailing that was sent out attempting to make providers believe it came from the OCR. Please share this information with your Compliance Office. The information from the OCR is below.
OCR has been made aware of postcards being sent to health care organizations disguised as official OCR communications claiming to be notices of a mandatory HIPAA compliance risk assessment. The postcards have a Washington, D.C. return address and the sender uses the title “Secretary of Compliance, HIPAA Compliance Division.” The postcard is addressed to the health care organization’s HIPAA compliance officer and prompts recipients to visit a URL, call, or email to take immediate action on a HIPAA Risk Assessment. The link directs individuals to a nongovernmental website marketing consulting services."
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Macs are resuming post payment medical reviews as of August 17, 2020 of items and services provided before March 1, 2020
As published on 8/6/2020 in CMS mln..."To protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities. Beginning August 17, the MACs are resuming with post-payment reviews of items/services provided before March 1, 2020. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate."
APDA encourages members to share this with their compliance officer and review your medical record documentation protocol.
HHS Secretary’s Report Calls for Congressional Action to Combat Surprise Billing and Promote Price Transparency
As published by HHS on July 29, 2020...."The report, called for in Section 7 of President Trump’s Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients First, outlines critical steps, including Congressional action, to implement the Administration’s principles on surprise billing. Sound surprise billing legislation will not only protect patients but will encourage a fairer, more transparent, patient-centered healthcare system that benefits all Americans.
Two key Target issues are:
- Patients are often hit with surprise bills after receiving emergency care from an out-of-network provider, when they could not choose their provider.
- Patients also often receive surprise bills at highly inflated prices after receiving care from an out-of-network provider they reasonably assumed was in their network.
Providers should be particularly aware of the 2nd target if you perform services for patients that may be unaware that you are out of network. Providers may consider protocols to inform out of network patients.
HHS believes:
- Patients receiving emergency care should not be forced to shoulder extra costs billed by a care provider but not covered by their insurer.
- Patients receiving scheduled care should have information about whether providers are in or out of their network and what costs they may face.
- Patients should not receive surprise bills from out-of-network providers they did not choose.
- Federal healthcare expenditures should not increase.
Reminder to Readers: Encrypt PHI on ALL mobile devices, create tracking of all PHI, maintain proper business associate agreements and privacy notifications to patients
HHS reports that....."On Saturday, February 25, 2017, a Rhode Island Hospital employee's car was broken into while it was parked in a public lot. One of the items stolen was a Mac Book laptop used by the employee for work purposes. The laptop was never recovered. Lifespan ascertained that the employee's work emails may have been cached in a file on the device's hard drive. The analysis revealed that the thieves had access to: patient names, medical record numbers, demographic information, including partial address information, and the name of one or more medications that were prescribed or administered to patients. The protected health information on the stolen laptop may have included information for patients across various affiliated provider facilities and belongs to Rhode Island Hospital, Lifespan Pharmacy LLC, retail pharmacies and affiliated hospitals of Lifespan. HHS' investigation indicated the following covered conduct occurred ("Covered Conduct")
A. Lifespan did not implement policies and procedures to encrypt all devices used for work purposes (see 45 C.F .R. § I 64.312(a)(2)(iv));
B. Lifespan did not implement policies and procedures to track or inventory all devices that access the network or which contain ePHI (See 45 C.F.R. § 164.3 lO(d)(l));
C. Lifespan did not have the proper business associate agreements in place between Lifespan Corporation and the Lifespan healthcare provider affiliates that are members ofthe Lifespan ACE (See 45 C.F.R. § 164.502(e)); and
D. Lifespan impermissibly disclosed the PHI of 20,431 individuals (see 45 C.F.R. § 164.502(a)).
Lifespan has agreed to pay $1,040,000 to the Office for Civil Rights (OCR) at HHS and to implement a corrective action plan to settle potential HIPAA violations and Privacy and Security Rules related to the theft of an unencrypted laptop.
"Laptops, cellphones, and other mobile devices are stolen every day, that’s the hard reality. Covered entities can best protect their patients’ data by encrypting mobile devices to thwart identity thieves,” said Roger Severino, OCR Director.
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Renewed ABN: Due to Covid-Deadline Extended to January 1
HHS gives providers a Second Chance-Reopens portal for certain Medicare Providers to apply for additional funds.
As published by HHS...."Starting the week of August 10, HHS will allow Medicare providers who missed the opportunity to apply for additional funding from the $20 billion portion of the $50 billion Phase 1 Medicare General Distribution. In April, to expedite providers getting money as quickly as possible, as they faced the financial hardships stemming from suspended elective procedures and other COVID-19 related impacts, HHS, utilizing the Centers for Medicare and Medicare Services (CMS) payment information, distributed $30 billion directly to Medicare providers proportionate to their share of 2019 Medicare fee-for-service reimbursements. This was part one of the $50 billion Phase 1 Medicare General Distribution which sought to offer providers financial relief equal to 2 percent of their annual revenues. Providers that do not submit comprehensive cost reports with CMS were asked to submit revenue information to a portal to receive the balance of their 2 percent payment of General Distribution funds. Some providers, including many Medicaid, CHIP, and dental providers with low Medicare revenues, did not complete an application by the deadline for this additional $20 billion round of funding. HHS, in its principle of ensuring fairness in the administration of the Provider Relief Fund program, is now giving those eligible providers another opportunity to apply for additional funding. They will have until August 28, 2020, to complete an application to be considered for the balance of their additional funding up to 2 percent of their annual patient revenues.
Payments for Providers Who Had a Change in Ownership
As previously noted, HHS relied on 2019 CMS payment data on file to determine automatic payments for $30 billion of the $50 billion Phase 1 Medicare General Distribution. Accordingly, some providers or provider practices that experienced a change in ownership in 2020 missed out on payments as the payments were distributed to the previous owners. Prior owners are required to return the payments to HHS, if they cannot attest to providing diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 on or after January 31, 2020. For program integrity considerations, previous owners are precluded from transferring funds to new owners who may qualify and can attest to providing care for possible or actual COVID 19 cases. HHS did not reissue returned payments to the new owners and instead promised to give new owners a separate opportunity to apply for provider relief funding. That opportunity is now here. Starting the week of August 10, providers who experienced change in ownership challenges may submit their revenue information, along with documentation proving a change in ownership, by August 28 for consideration for Provider Relief Fund payment.
HHS is currently working to address relief payments to new providers in 2020 along with those that have yet to receive any funding for a variety of reasons, including the fact that they may only bill commercially, or do not directly bill for the services they provide under the Medicare and Medicaid programs and thus did not receive any funding yet. Future announcements will be provided. For updated information and data on the Provider Relief Fund, visit: hhs.gov/providerrelief."
CMS is temporarily ceasing revalidation efforts for all Medicare providers or suppliers
"During the public health emergency, CMS will not issue any new revalidation notices, deactivate providers who fail to respond to revalidation requests, or update the Medicare Revalidation Tool at https://data.cms.gov/revalidation with new revalidation due dates. Revalidation applications submitted to your MAC will continue to be processed but not in an expedited manner. Upon the lifting of the public health emergency, CMS will resume revalidation activities.
- All Due Dates will not be removed and will continue to be displayed on the website even after a Provider has revalidated successfully.
- All Due Dates that are ‘TBD’ will hereafter display a blank in the dataset but will continue to display as ‘TBD’ on the search results pages.
- This data was last refreshed on February 28th (in lieu of March1st which is a Sunday)
- Revalidation due dates included on this list range between March 31st, 2016 and September 30th, 2020
- The next data refresh is tentatively scheduled for May 1st, 2020
- Affiliations now include Reassignments as well as PA Employment Relationships
- Data now includes DME Due Dates between November 1st, 2016 and September 30th, 2020
- DME Suppliers are identified on the downloadable file in a new column called “Enrollment Type” and are identified as “1”
Businesses want Liability Shield in second Stimulus Package
As published in Forbes..."The next hot button issue in the second round of stimulus legislation isn’t about payroll or unemployment checks. Instead, the parameters of proposed liability protections for businesses have taken center stage in negotiations over the $1 trillion Help, Economic Assistance, Liability Protection and Schools (HEALS) Act."
“If you're a small business, the filing of a lawsuit, even if it doesn't go anywhere, consider the time that it takes, the deductible kicking in, the burden of potentially having to settle. The nature of litigation is that the costs are significant,” says Tiger Joyce, president of the American Tort Reform Association. “The legal system does not work well when there’s great uncertainty.”
"Advocates of the liability protections believe these safeguards will enable businesses to operate without the risk of an employee or customer claiming they contracted COVID-19 on the premises and taking legal action.
Detractors of the liability legislation say that widespread immunity from lawsuits would unfairly place the burden of proof on an employee or customer to definitively show that they contracted the virus within a particular business or workplace, an onerous task given the current lag times between taking a coronavirus test and receiving the results."
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The Value of APDA Membership
APDA is the only association representing the Portable Diagnostic industry.
This industry needs your support........
A strong membership is key to fighting for your issues, reimbursement and representation. Learn More
Empower your business with benefits for APDA Members only
Not a Member? Don't wait! - There has never been a better time to be a member
-Discounts on conference registration fees
-Access to Industry Vendor special pricing
-Special emails and Updates on the latest news and policy developments dedicated to Portable Diagnostic Providers sent to Members Only
-Receive a MEMBERS ONLY complete edition of APDA's Monthly e-News
-Quarterly Webinars -FREE to members only
-Unmatched opportunities to network with fellow Portable Diagnostic Providers
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APDA Thanks & Appreciates Its Members and their Staff for the Hard work and contributions they make everyday as essential workers-caring for and keeping our elderly patients safe during this Covid Pandemic! |
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Questions or comments? We would like to hear from you!
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