The OIG’s Overhaul of Compliance Guidelines: What You Need to Know

Sep 20, 2023 | Uncategorized

In a significant development for the healthcare industry, the HHS Office of Inspector General (OIG) has announced a major overhaul of compliance guidelines for individual and small group physician practices. This much-anticipated update comes after nearly 23 years and is part of the OIG’s broader modernization plan. As healthcare compliance experts, Welter Healthcare Partners is committed to keeping you informed and helping you navigate these changes to develop strong and efficient compliance programs. In this article, we will delve into the details of the OIG’s planned revisions and what they mean for your practice.

The Roadmap to Modernization

The OIG’s modernization plan, outlined in the Federal Register notice titled “Modernization of Compliance Program Guidance Documents,” aims to provide updated and comprehensive compliance guidance for healthcare entities. The first round of upgrades is expected to be rolled out by the end of 2023, starting with the general compliance program guidance (GCPG).

Key Areas of Focus

The GCPG will cover a wide range of critical topics, including:

• Federal Fraud and Abuse Laws: Understanding and complying with federal fraud and abuse laws is paramount for healthcare providers. The updated guidelines will offer clarity on these laws and how they apply to your practice.
• Compliance Program Basics: Establishing a robust compliance program is the foundation of ensuring ethical and lawful healthcare operations. The GCPG will provide insights into the fundamental elements of such programs.
• Operating Effective Compliance Programs: Practical guidance on how to operate and maintain an effective compliance program will be a central focus. This will help healthcare entities streamline their processes and ensure ongoing compliance.
• OIG Processes and Resources: Understanding how the OIG operates and the resources available for compliance will be essential for healthcare providers. The guidelines will shed light on these aspects to facilitate cooperation and communication.

Timeline for Implementation

The OIG plans to publish the GCPG by the end of the calendar year 2023. Subsequently, industry-specific guidance will follow in 2024. These tailored guidelines will be designed to meet the unique needs of various healthcare providers, suppliers, and participants in different subsectors of the healthcare industry.

The OIG’s initial target for industry-specific guidance includes Medicare Advantage and nursing facilities. However, over time, guidelines for other healthcare sectors are expected to be developed. Importantly, the OIG has confirmed that these compliance guidelines will remain voluntary.

Embracing Voluntary Compliance

The OIG’s intention has always been to create a voluntary set of guidelines and identified risk areas. These guidelines are meant to assist individuals and entities in the healthcare industry when developing or evaluating their compliance programs. While they are not mandatory, adhering to these guidelines demonstrates a commitment to ethical and lawful healthcare practices.

How Welter Healthcare Partners Can Help

At Welter HP, we provide a comprehensive suite of coding services tailored to meet all the coding needs of your medical practice. Our dedicated team excels in compliant coding, precise documentation, and efficient billing practices. With the impending changes in compliance guidelines, our team will be diligently tracking the OIG’s revisions as they are announced. We are dedicated to helping our clients adapt to these changes and develop compliance programs that align seamlessly with the new guidance.

The OIG’s overhaul of compliance guidelines for individual and small group physician practices marks a significant step towards modernizing compliance in the healthcare industry. While the changes are expected to be rolled out gradually, it is crucial for healthcare providers to stay informed and prepared. Welter HP is here to support you through this transition, ensuring that your compliance programs remain strong, efficient, and aligned with the evolving guidelines. Together, we can continue to uphold the highest standards of ethical and lawful healthcare practices.

Talk to an expert today!

CMS Vaccine Mandate Update: Last, but Not Least, Texas Joins the Rest of the Country

Feb 9, 2022 | Uncategorized

nnTexas is now the last State to determine its vaccine mandate guidelines. The Centers for Medicare and Medicaid Services set forth guidelines, by February 19, 2022, Texas must have its vaccination processes and plans in place, and all covered staff must at least have taken their first dose of a vaccine or have a pending exemption request to be in compliance with the CMS rule. By March 21, 2022, all covered staff must be fully vaccinated against COVID-19 or have received an exemption to be in compliance with the CMS rule. Continue reading below to learn more. nn nOn January 13, 2022, the Supreme Court of the United States issued an opinion staying preliminary injunctions issued in cases filed in Missouri and Louisiana challenging the Centers for Medicare and Medicaid Services (CMS) COVID-19 vaccination mandate for healthcare providers. The ruling stayed preliminary injunctions applicable to twenty-four states. Twenty-five states were already subject to enforcement under the CMS rule. This left Texas standing alone and in limbo.nn nnDismissal of the Texas CasennOn January 14, 2022, CMS filed in the U.S. District Court for the Northern District of Texas a motion to stay the preliminary injunction applies to the State of Texas, pending the resolution of an interlocutory appeal that CMS filed with the U.S. Court of Appeals for the Fifth Circuit on the same day. The district court ordered the State of Texas to file its response to CMS’s motion by January 18, 2022.nnOn January 18, 2022, the State of Texas filed a motion to dismiss the case without prejudice. It also filed a response to CMS’s motion for stay, arguing that it was moot because Texas sought to dismiss the case.nnCMS filed a reply memorandum on January 19, 2022, arguing that its motion to stay was not moot until the case was dismissed and requesting that the court either grant its motion to stay or dismiss the case by 5:00 p.m. on January 19, 2022.nnThe district court issued an order dismissing the lawsuit without prejudice on January 19, 2022, allowing CMS to enforce the vaccine mandate nationwide.nn nnNew CMS Deadlines Applicable to TexasnnOn January 20, 2022, CMS issued new guidance setting forth the following compliance deadlines for Texas:n

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• By February 19, 2022, covered facilities in Texas must have their vaccination processes and plans in place, and all covered staff must at least have taken their first dose of a vaccine or have a pending exemption request to be in compliance with the CMS rule.

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• By March 21, 2022, all covered staff must be fully vaccinated against COVID-19 or have received an exemption to be in compliance with the CMS rule.nAll prior deadlines set for the other forty-nine states remain unchanged.

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n nnTakeawaysnnCovered facilities in Texas may want to consider dusting off their vaccination processes and plans and restarting the implementation process if they have not already done so. With Texas’s state vaccine executive order in conflict with the CMS rule, Texas employers may also want to ensure their policies make clear that their CMS-compliant policies apply to CMS-covered facilities and preempt the executive order. On the other hand, for any employee not working in a CMS-covered facility, another policy and/or the provisions of the executive order may apply to them.nnOgletree Deakins will continue to monitor and report on developments with respect to the COVID-19 pandemic and will post updates in the firm’s Coronavirus (COVID-19) Resource Center as additional information becomes available. Important information for employers is also available via the firm’s webinar and podcast programs.nnOriginal article published on ogletree.com

CMS Proposed Bi-Annual ICD-10 Implementation Dates

Apr 22, 2021 | Uncategorized

CMS proposed bi-annual ICD-10 implementation dates that would be in addition to previous coding from last October. With the ongoing COVID-19 pandemic, the industry has had to adapt and evolve quickly. Of course, with new coding comes new standards for the medical industry. Read more below to see the new CMS proposed bi-annual coding dates. nnIn the March 2021 virtual ICD-10 Coordination and Maintenance Committee meeting, the Centers for Disease Control and Prevention’s National Center of Health Statistics (CDC/NCHS) and the Centers for Medicare and Medicaid Services (CMS), announced a new proposal to introduce an April 1st implementation date for ICD-10-CM & ICD-10-PCS updates. This April 1 implementation would be in addition to our existing October 1 implementation for code set updates and revisions, and would be considered under Social Security Act section 1886(d)(5)(K)(vii).nnThis proposal is, in part, due to lessons learned from the ongoing COVID-19 Public Health Emergency (PHE) and the need for the healthcare industry to adapt quickly to rapidly evolving industry standards and the impact it has on the business of medicine. The Committee concluded with a call for public comments on this proposal. All comments must be submitted by May 7, 2021 to CMS at ICDProcedureCodeRequest@cms.hhs.gov.n

To learn about the pros and cons of the proposed bi-annual ICD-10 implementation dates, please click here.

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House has Delayed Medicare Sequester Cuts Through 2021

Apr 16, 2021 | Uncategorized

The house has delayed Medicare 2% sequester cuts through 2021. Sequestration cuts were originally supposed to be implemented this month, however, Congress has acknowledged how detrimental this may be to providers and patients and this has ultimately prompted the extension. Continue reading below to find out more.nnPresident Biden is expected to sign the bill, which has already cleared the Senate.nnKey Takeaways:n

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• To pay for the estimated $18 billion in delayed cuts, the bill increases the fiscal year 2030 sequester cuts.

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• The bill also tweaks the rural health clinic provisions in the Consolidated Appropriations Act, 2021.

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• Specifically, requirement that the payment rate for RHCs be capped at $100 per visit beginning April 1, 2021.

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• The rate will increase gradually based on the Medicare Economic Index, but the AHA said it will remain well below typical provider-based RHC rates.

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• Medicare also faces a separate 4% cut — about $36 billion — owing to the Pay-as-You-Go provisions that kicked in to offset the cost of the American Rescue Plan Act.

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• The House had already passed a bill eliminating PAYGO for the stimulus bill, but the Senate did not act on it.

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nA bipartisan U.S. House on Tuesday night voted 384-38 to delay until the end of 2021 Medicare’s reviled 2% across-the-board sequestration cuts that were supposed to take effect on April 1. The Senate passed the bill 90-2 last month and President Joseph R. Biden is expected to sign it in the coming days. To pay for the estimated $18 billion in delayed cuts, the bill increases the fiscal year 2030 sequester cuts. American Medical Association President Susan R. Bailey, MD, said the overwhelming support in Congress for delaying the cuts “acknowledges that cutting Medicare payments during a pandemic is ill-conceived policy.”nn”Physician practices are already distressed, and arbitrary 2% across-the-board Medicare cuts would have been devastating,” she said. Rick Pollack, president and CEO of the American Hospital Association, said the delay was needed while hospitals and clinicians contend with the coronavirus pandemic and ongoing vaccination efforts. “Even though our country is making great progress by vaccinating millions of people a day, it is clear that this pandemic is far from over and that there is an urgent need to keep hospitals, health systems, and our heroic caregivers strong,” Pollack said.nnAnders Gilberg, senior vice president, government affairs, at the Medical Group Management Association, said his association was “relieved that Congress heeded our call to protect medical groups from the arbitrary 2% Medicare sequester cuts through the end of 2021.” “MGMA has long opposed the sequester cuts, a tax that penalizes medical practices for Congress’ inability to meaningfully address the country’s budgetary affairs,” Gilberg said. “To reinstate the Medicare sequester in the middle of a global pandemic would threaten the viability of physician practices and adversely impact the patients they treat.”nnWith the extension in place, Gilberg urged Congress “to work in a bipartisan manner to expeditiously pass legislation that would prevent an additional 4% Medicare spending cut next year due to the budgetary effects of the American Rescue Plan.” The bill also tweaks the rural health clinic provisions in the Consolidated Appropriations Act, 2021. Specifically, the requirement that the payment rate for RHCs be capped at $100 per visit beginning April 1, 2021. The rate will increase gradually based on the Medicare Economic Index, but the AHA said it will remain well below typical provider-based RHC rates.nnThe bill also includes both Medicare-enrolled RHCs located in a hospital with less than 50 beds and RHCs that have applied for Medicare enrollment as of this date. Medicare also faces a separate 4% cut — about $36 billion — owing to the Pay-as-You-Go mandates that offset the cost of the American Rescue Plan Act. The House had already passed a bill eliminating PAYGO for the stimulus bill, but the Senate did not act on it.nnPollack said the AHA will continue to press Congress and the Biden administration for more “support, resources and tools” for the nation’s hospitals. “This includes continuing to advocate for more overall funding for the Provider Relief Fund, relief for hospitals and health systems with Medicare accelerated payments, hospital and health system priorities to be included in the upcoming infrastructure legislative package and Congressional action by the end of the year on Medicare cuts due to the effects of PAYGO,” he said.nn“To reinstate the medicare sequester in the middle of a global pandemic would threaten the viability of physician practices and adversely impact the patients they treat.”n-Anders Gilberg, MGMA nnOriginal article published on healthleadersmedia.com

CMS Pauses Claim Payments Until Congress Passes Sequester Fix

Apr 8, 2021 | Uncategorized

CMS pauses payment claims submitted after April 1st until Congress passes the sequester bill. As ideas of the sequester extension have been thrown around, CMS has paused payments to minimize the volume of claims that would be reprocessed. More news should come out soon as Congress returns from recess. Read below to find more about CMS updates. nnThe House is on recess but expected to pass the bill when it returns to Washington, D.C., on April 13. A version of this article was first published April 5, 2021, by HCPro’s Revenue Cycle Advisor, a sibling publication to HealthLeaders. CMS is holding payments for claims submitted on or after April 1 in anticipation of legislation that will extend the suspension of a 2% cut (sequester) to all Medicare payments, according to a special edition of MLN Connects.nnThe Senate recently passed a bill that would eliminate the 2% sequestration of Medicare reimbursements through the end of 2021. The House is on recess but expected to pass the bill when it returns to Washington, D.C., on April 13. According to CMS, temporarily withholding payments will “minimize the volume of claims the MACs [Medicare Administrative Contractors] must reprocess if Congress extends the suspension.” MACs will reprocess any claims paid with the reduction applied, if necessary.nnExtension of the sequester is a major priority for the American Medical Association, American Hospital Association, and other physician groups who believe the 2% payment cut would financially devastate already distressed physician practices. Revenue Cycle Advisor combines all of HCPro’s Medicare regulatory and reimbursement resources into one handy and easy-to-access portal. News is not just repeated from other sources. It is analyzed by our Medicare experts so professionals can comprehend any new rule and regulatory updates thoroughly.nnOriginal article published on healthleadersmedia.com