As of April 15, 2020_9am EST
COVID-19 is a once in a hundred year pandemic. SunHawk Consulting is committed to providing timely and relevant information to help Compliance and Legal Professionals in the health care and life sciences industry manage risk in this evolving regulatory environment. Below please find survey results from conversations with clients as well as experts managing the COVID-19 risks for Payers, Providers and Life Science Entities throughout the US. This survey will be updated as new details emerge. Please reach out to one of our experts if you have any questions or click on this link.
Observations Impacting Most Providers
Medicare Advantage vs. Medicare Part A & B Waivers:
We received increasing number of questions over the month related to confusion between mandatory vs. permissive changes waivers related to traditional Medicare Part A and B and Medicare Advantage Organizations (MAO). On March 10, 2020, CMS published a useful Memo detailing “Special Requirements” vs. “Permissive Actions”.
One sometimes confusing, however commonly provided waiver during national emergency’s, is that of gatekeeper referrals.
Free Analysis of Legislative, Regulatory and Executive orders, by State:
Lexis Nexis has published a free interactive webpage providing State by State analysis that tracks Legislative, Regulatory and Executive orders related to Covid-19.
Increases In Remote Workforce Come with Challenges For All Clients Surveyed:
Extremely helpful guide on telework and remote access to help organizations mitigate security risks was published on March 18, 2020 by US Department of Commerce NIST, Information Technology Laboratory.
Quick one page Guidance for COVID-19 Claim Filings, published on March 23, 2020, by National Uniform Billing Committee addresses:
Appropriate flagging of COVID-19 Care for Institutional Claims, including patients that tested negative.
Outpatient billing for Hospitals that are moving testing locations to off-campus facilities (e.g. parking lots, parks, football stadiums).
Increased HIPAA Risks With Less Restrictive HIPAA Rules:
Clients report hospital staff checking medical records to see if patients have tested positive for COVID-19. The government is relaxing measures to help ensure patients get proper treatment during this crisis. However, that doesn’t give staff the right to check out patients’ medical records to see if they have tested positive for COVID-19.
Services Provided To Medicaid Beneficiaries:
In order to increase the probability of payment make sure the applicable State 1135 Waver allows for payment. See the states below that have requested 1135 Waivers and which have received Approvals related to Provider Enrollment. Click on the link below for the most current State by State Analysis.
Provider Services Under Less Restrictive Telehealth Rules:
Current Federal Guidance:
Be cognizant of creative physicians providing Telehealth services. One client said, “Can you provide a hearing test over the phone?”
Skilled Nursing Facilities
CMS has waived the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay for people who need to be transferred as a result of the effect of a disaster or emergency.
CMS also provided temporary relief to SNFs related to timely submissions of Minimum Data Sets assessments/transmission.
Helpful Legal and HR Operating Guidance Resources
General legal perspectives on COVID-19 including frequently asked questions. https://www.fisherphillips.com/faqs
Comprehensive corporate human resource officer guidance regarding COVID-19 response. https://www.gallup.com/workplace/292334/covid-strategies-policies-world-largest-companies.aspx
Ramping Up Virtual Project Management / Team Facilitation in Response to COVID-19? SunHawk Can Help
Our skilled leaders and professionals at SunHawk are experts at managing complex and time sensitive projects in a virtual on-line world. In these disruptive times, we can jump in to help your organization with regulatory and compliance management needs including:
· Organizing a short-term crisis management/response team,
· Facilitating or assume leadership of a new compliance initiative, or
· Provide leadership to an established team or add additional expertise.
Do you have work that needs to be done? Do you not have the immediate bandwidth or resources to see such projects to fruition given other priorities? We can help, please reach out to Jim Rough or James Rose for assistance:
SunHawk Consulting is a team of highly skilled and experienced subject matter experts in the Healthcare, Life Sciences, and Insurance Industries who understand that the client’s needs and budgets come first. SunHawk provides Crisis Management Response, Compliance Consulting, Disputes & Investigations, and Staff Augmentation services for Boards of Directors, internal/external legal counsel, company management and employees, special committees, bankruptcy trustees and receivers, and government agencies.