Long-Term Care Facilities Reopening After COVID-19 Lockdown

States, counties and cities nationwide are currently at varying levels of reopening their economies after the coronavirus outbreak. Some states, such as Texas and Florida, have backtracked by closing off various businesses again after a surge of COVID-19 cases in those areas. Such instances have made governors wary of reopening too quickly, especially in the states that were hit the hardest at the onset of COVID-19’s entry to the U.S. – New York and New Jersey. Given the tragic loss experienced in nursing homes and the known impact that this virus has on seniors, long-term care facilities (including nursing homes and assisted living facilities) may be among the last business to undergo a “reopening.” Strict adherence to the federal, state and local precautions will be required, as well as close monitoring for outbreaks in the facility. This article discusses what “reopening” means for these facilities since they were not technically closed in the way that most other businesses were. Then, it will cover the recent CMS recommendations to state and local officials on reopening nursing homes as states progress through the phases of the White House Guidelines for Opening Up America Again.

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Insurers Preempting Upcoming Changes for E/M Visit Documentation

On November 15, 2019, the Centers for Medicare and Medicaid (“CMS”) published the 2020 Physician Fee Schedule Final Rule in the Federal Register. Among the several changes outlined in the rule, this post specifically focuses on the changes to documentation requirements for Evaluation and Management (“E/M”) Visits. The first important note is the CMS will maintain the existing documentation requirements for all E/M codes for the year 2020.

However, in an effort to update the currently applicable guidelines (published in 1995 and 1997), the E/M documentation requirements will be revamped in 2021 for office visits only. In other words, the emergency department E/M code documentation will remain unchanged. But the focus of the E/M code documentation for office visits will be based solely on Medical Decision-Making (“MDM”) or E/M visit time with patient. Continue reading “Insurers Preempting Upcoming Changes for E/M Visit Documentation”

New CMS Final Rule Strengthens Enforcement Authorities To Bolster Fraud and Abuse Prevention

On September 5, 2019, the Centers for Medicare and Medicaid Services (“CMS”) issued a final rule that strengthens a number of enforcement measures.  The new rules go into effect beginning November 4, 2019.  The goal for CMS is to keep those providers and suppliers that have committed fraud out of the federal healthcare programs.

For one, the new final rules provide CMS with new revocation and denial authorities, as part of the Provider Enrollment Process, for “affiliations” that pose an undue risk of fraud, waste or abuse. Continue reading “New CMS Final Rule Strengthens Enforcement Authorities To Bolster Fraud and Abuse Prevention”