APDA News & Covid-19 Updates June 2020
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Topics for today's Newsletter
- Read about how APDA is working on behalf of PXR and IDTF providers for fair & equal transport rates, additional reimbursement for Covid 19 related expenses, and increased overall recognition for the industry.
- Learn how you can help with this initiative.
- Deadline is approaching for Novitas members to return their Covid 19 cost study.....please help APDA help you......
- Learn about CMS sweeping changes to Provider Enrollment
- Read about new Corporate Compliance DOJ guidance updates & how this could affect your business
- Reminder of Medicare Signature requirements
- Read about Important Covid 19 Updates and details
- Mark your Calendar for APDA's Fall Conference & Expo-see details below
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APDA Covid 19 cost study was sent to 41 PXR companies on 5/28/2020
This study incorporates expenses incurred by pxr providers, such as: masks, gloves, gowns, shoe covers, testing costs, hand sanitizers, covers for digital panels, cleaning supplies, tech time and wages for Covid screening before entering the facility, tech time and wages for donning and removing PPE along with cleaning equipment, overtime, costs due to tech being turned away and more.
APDA is asking providers who have received this survey to plug in your cost data on the provided spreadsheet along with adding a narrative (one paragraph) on how the Covid 19 pandemic has affected your business and
return the worksheet to
Will Irwin, APDA President
and
Ryan Kingrey, APDA President elect
by
June 10, 2020.
We realize you already have incurred unexpected expenses due to Covid 19 and APDA is working hard on your behalf to ask for additional funds to cover these costs while funds may still be available. Time is of the essence.....As soon as we receive your data, we will present it to CMS and DC Legislators. I am sure you agree that this initiative is vital to your business.....so please take the time to complete and return your survey and return it by June 10, 2020
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Mark your Calendar for APDA's Fall Annual Conference and Expo!
We will be heading to Austin Texas - October 6th-8th, 2020
This year's annual conference promises to be most exciting - with members and industry peers sharing their experiences as related to Covid-19, R0070 initiative updates and the ever changing industry landscape of rules, regulations and policies.
Learn more and join this year's Annual Conference designed for business owners, CEOs, CFOs, operations managers, administrators and diagnostic executives
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In the Fall of 2019 APDA reported in our newsletter upcoming rule changes with increased enforcement and oversight of the Medicare, Medicaid and CHIP program enrollment processes.
On May 22, 2020 CMS has announced Phase 1 change request 1155 publication 100-08- transmittal 10146 which will implement the provider enrollment-related provisions in CMS-6058-FC and continue removing instructions found in Chapter 15 of Pub.100-08 and moving those instructions to Chapter 10 of Pub. 100-08.
Effective date is July 24, 2020.
What does this Mean????
As CMS reported in September 2019 .......
The final rule, Program Integrity Enhancements to the Provider Enrollment
Process (CMS-6058-FC), creates several new revocation and denial authorities to bolster CMS’ efforts to stop waste, fraud and abuse. Importantly, a new “affiliations” authority in the rule allows CMS to identify individuals and organizations that pose an undue risk of fraud, waste or abuse based on their relationships with other previously sanctioned entities. For example, a currently enrolled or newly enrolling organization that has an owner/managing employee who is “affiliated” with another previously revoked organization can be denied enrollment in Medicare, Medicaid, and CHIP or, if already enrolled, can have its enrollment revoked because of the problematic affiliation.
The rule also includes other authorities that will effectively improve CMS’ fraud-fighting capabilities. Similar to the affiliations component, these authorities provide a basis for administrative action to revoke or deny, as applicable, Medicare enrollment if:
- A provider or supplier circumvents program rules by coming back into the program, or attempting to come back in, under a different name (e.g. the provider attempts to “reinvent” itself);
- A provider or supplier bills for services/items from non-compliant locations;
- A provider or supplier exhibits a pattern or practice of abusive ordering or certifying of Medicare Part A or Part B items, services or drugs; or
- A provider or supplier has an outstanding debt to CMS from an overpayment that was referred to the Treasury Department.
The new rule also gives CMS the ability to prevent applicants from enrolling in the program for up to 3 years if a provider or supplier is found to have submitted false or misleading information in its initial enrollment application. Furthermore, the new rule expands the reenrollment bar that prevents fraudulent or otherwise problematic providers from re-entering the Medicare program. CMS can now block providers and suppliers who are revoked from re-entering the Medicare program for up to 10 years. Previously, revoked providers could only be prevented from re-enrolling for up to 3 years. Additionally, if a provider or supplier is revoked from Medicare for a second time, CMS can now block that provider or supplier from re-entering the program for up to 20 years.
Providers should expect possibly other phases to the PIM provider enrollment processes in the future. APDA will continue to look out for updates and pass them to members.
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Corporate compliance continues to be a major focus for the DOJ and OIG. These updates remind providers of the importance of taking proactive steps to maintain an organic corporate compliance policy and management program.
As per updated guidance from DOJ
"...... considers various factors including, but not limited to, the company’s size, industry, geographic footprint, regulatory landscape, and other factors, both internal and external to the company’s operations, that might impact its compliance program. There are, however, common questions that we may ask in the course of making an individualized determination. As the Justice Manual notes, there are three “fundamental questions“ a prosecutor should ask:
- “Is the corporation’s compliance program well designed?“
- “Is the program being applied earnestly and in good faith?“ In other words, is the program adequately resourced and empowered to function effectively?
- “Does the corporation’s compliance program work“ in practice?"
As per Arnold and Porter news and perspectives...
."
While DOJ has previously emphasized that compliance programs must be dynamic and responsive, with risk assessment processes that are "current and subject to periodic review," the 2020 Compliance Guidance directs prosecutors to go further and ask whether such reviews are "limited to a 'snapshot' in time or based upon continuous access to operational data and information across functions" and whether periodic reviews have "led to updates in policies, procedures, and controls." Companies should be "tracking and incorporating into [their] periodic risk assessment lessons learned either from the company's own prior issues or from those of other companies operating in the same industry and/or geographical region." DOJ will also consider whether a company "review[s] and adapt[s] its compliance program based upon lessons learned from its own misconduct and/or that of other companies facing similar risks."
Documentation must meet Medicare’s signature requirements. If Medicare claims reviewers cannot validate the signatures, MACs deny the claim, assess an error, and begin recouping overpayments Physicians are asked:
How are orders treated differently than other medical documentation? “Orders” are your authorizations for tests, plans of care, and procedures, and are considered part of the overall medical record. You must validate orders with a timely signature. In some cases, laws or regulations say you must sign the order before starting the service. Generally, unsigned orders in those situations are not subject to signature attestation, and the reviewer will disregard them.
However, exceptions are made for certain clinical diagnostic tests if you signed a progress note in the medical record showing your intent to order the tests (see Medicare Benefit Policy Manual,Chapter 15, §80.6.1)." You cannot create missing orders after the fact to backdate a plan of care or other service. If the medical record has no order for a service, Medicare will deny payment for the service. “Medical documentation” consists of, among other things, notes, lab results, and clinical observations as well as orders. Missing signatures on medical documentation other than orders are subject to signature attestation. "
What should I do if I did not sign an order or medical record? "You may not add late signatures to orders or medical records (beyond the short delay that occurs during the transcription process) Medicare does not accept retroactive orders. If your signature is missing from the medical record (
other than an order), you may submit an attestation statement. Your contractor may offer specific guidance regarding signature attestation statements, including whether current laws or regulations allow attestation for missing signatures in certain situations.
For certain unsigned test orders, submit progress notes showing intent to order the tests. The progress notes must be authenticated by your valid signature. If the orders and the progress notes are unsigned, a claims reviewer will disregard the order, and your facility or practice will be assessed an error, which may involve recouping an overpayment."
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- The PPP Flexibility Act changes the amount of loan needed for payroll to 60%
- Borrowers now have 24 weeks to spend loan proceeds, up from 8 weeks.
- Pushes back a June 30th deadline to rehire workers to December 31, 2020
- Eases rehire requirements
- Extends repayment term from 2 years to 5 years
- Two new exceptions let borrowers obtain full forgiveness even without fully restoring their workforce.
- The Act now lets businesses delay paying payroll taxes even if they took a PPP loan.
Public Law 116-136, § 18115(a), the Coronavirus Aid, Relief, and Economic Security (CARES) Act, requires “every laboratory that performs or analyzes a test that is intended to detect SARSCoV-2 or to diagnose a possible case of COVID-19” to report the results from each such test to the Secretary of the Department of Health and Human Services (HHS). In addition, the statute authorizes the Secretary to prescribe the form and manner, and timing and frequency, of such reporting. This document outlines the requirements for data submission to HHS as authorized under this law. In an effort to receive these data in the most efficient and effective manner, the Secretary is requiring that all data be reported through existing public health data reporting methods, described below. As a guiding principle,
data should be sent to state or local public health departments using existing reporting channels (in accordance with state law or policies) to ensure rapid initiation of case investigations by those departments, concurrent to laboratory results being shared with an ordering provider, or patient as applicable.
Entities required to report: All laboratories—including laboratories, testing locations operating as temporary overflow or remote locations for a laboratory, and
other facilities or locations performing testing at point of care or with at-home specimen collection related to SARS-CoV-21 —
shall report data for all testing completed, for each individual tested, within 24 hours of results being known or determined, on a daily basis to the appropriate state or local public health department based on the individual’s residence
Read More
"Under OSHA's recordkeeping requirements, COVID-19 is a recordable illness, and thus employers are responsible for recording cases of COVID-19, if:
- The case is a confirmed case of COVID-19, as defined by the Centers for Disease Control and Prevention (CDC);[2]
- The case is work-related as defined by 29 CFR § 1904.5;[3] and
- The case involves one or more of the general recording criteria set forth in 29 CFR § 1904.7.[4]"
The funds will support hospitals and other health care entities to train workforces, expand telemedicine and the use of virtual healthcare, procure supplies and equipment, and coordinate effectively across regional, state and jurisdictional, and local health care facilities to respond to COVID-19. In addition to directly supporting health care capacity for COVID-19 patient surge, this funding will advance the mission of the
National Special Pathogen System
to enhance national capacity and capability to respond to highly infectious diseases now and in the future.
- on-site surveys of nursing homes with previous COVID-19 outbreaks will be required and will be required to perform on-site surveys (within three to five days of identification) of any nursing home with new COVID-19 suspected and confirmed cases.
- for the first time, nursing homes are required to report COVID-19 cases and deaths directly to the CDC on an ongoing basis as the result of an unprecedented CMS regulatory requirement...
- CMS will take enforcement action against the nursing homes that have not reported data into the CDC as required under CMS participation requirements.
- CMS will post the underlying CDC-collected data on a link on Nursing Home Compare later this week...
- CMS is ratcheting up penalties for noncompliance with infection control
- Develop and implement appropriate policies, in accordance with Federal, State, and local regulations and guidance, and informed by industry best practices, regarding:
- Social distancing and protective equipment
- Temperature checks
- Testing, isolating, and contact tracing
- Sanitation
- Use and disinfection of common and high-traffic areas
- Business travel
- Monitor workforce for indicative symptoms. Do not allow symptomatic people to physically return to work until cleared by a medical provider.
- Develop and implement policies and procedures for workforce contact tracing following employee COVID+ test
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Q. My nursing homes are requiring my techs to be covid tested twice a week - is there anything I can do?
A. See the Reopening of Nursing Homes
guidelines that were released May 18, 2020 requiring nursing homes to create testing policies with a minimum of testing staff and others once a week. We ask that you share with APDA's executive committee how this is impacting your business. We will add your concerns to our advocacy initiatives with CMS.
Q. Does anyone have used EKG machines and supplies to donate to a non for profit organization - saving lives one day at a time through athletic physical exams and heart screening on young athletes?
A. Interested? Visit this link to learn about compelling stories from athletes, their families, contributions by Bobby Bowden (honorary board member), lives saved and how your donation to Who We Play For can make a difference.
https://www.whoweplayfor.org/
Q. Is anyone interested in
purchasing gowns
in bulk together? We have a need and can't get vendors to provide gowns unless we order a large quantity.
Q. Is there a guide on how to keep up with the actions my state is taking on nursing home infection control, testing, screening, PPE, etc.?
A. Yes.
CMS released a newly developed
Toolkit
to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes.
Q.
What changes did the currently passed PPP flexibility Act make to the non payroll portion of a forgivable covered loan amount?
Disclaimer:
The information provided above is for general informational and educational purposes only. All information shared does not contain any medical or legal advice. Accordingly, before taking any actions we encourage you to consult with appropriate professionals of your choice.
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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
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APDA Thanks & Appreciates Its Members and their Staff for the Hard work and contributions they make everyday as an essential worker-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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