- Separate each type of Relief Fund payment into its own account to track expenses;
- Review specific requirements for each Relief Fund payment’s terms and conditions;
- Create digital and/or paper files for each Relief Fund payment and related services;
- Assign a point person or accountant to conduct preliminary or random reviews of patient records and documentation of Relief Fund payment expenditures; and
- Consult with an attorney to review records and ensure compliance with all requirements.
Waivers & Flexibility
Starting in March, the HHS and the Centers for Medicare & Medicaid Services (CMS) released numerous blanket waivers and emergency flexibility for healthcare providers during the public health emergency. These include:
- CMS provider/practitioner cross-state practice and relaxed enrollment requirements;
- CMS reductions in certain paperwork, record documentation and signature requirements;
- CMS waivers for various Stark law arrangement sanctions;
- CMS physician supervision flexibility for certain procedures and practitioners; and
- CMS Medicare fee-for-service (FFS) flexibility for physician and hospital services.
The CMS clearly stated its focus on maintaining oversight for activities occurring during the public health emergency and will continue to monitor for accurate billing practices by coordinating with State Survey Agencies, the OIG and the U.S. Government Accountability Office. The OIG similarly announced in June that it would increase its focus on reviewing provider claims related to COVID-19 add-on testing due to the potential for fraud and abuse that may result from CMS waivers for provider ordering of COVID-19 tests.
In late March, the CMS suspended most Medicare FFS medical reviews, including for pre-payment medical reviews conducted by Medicare administrative contractors (MACs) under the Targeted Probe and Educate program, and post-payment reviews conducted by MACs, supplemental medical review contractors and recovery audit contractors. In July, the CMS indicated its intent to discontinue this enforcement discretion beginning Aug. 3, regardless of the public health emergency status.
Best practices: Providers should prepare a compliance plan to transition public health emergency waiver activities back to standard practices at the official end of the public health emergency, maintain thorough documentation of all public health emergency services and promptly conduct a preliminary review of all claims submitted directly following the end of the public health emergency.
If selected for a FFS review of public health emergency-related claims, providers should discuss any COVID-19-related hardships they have experienced that could affect audit response times with their MAC. Providers should likewise contact an attorney to examine any letters or notices of claims potentially selected for review to best prepare for possible appeals or other adverse actions.
