The Joint Commission COVID-19 Resources

April 30th, 2020

The Joint Commission, one of the nation’s top accreditation organizations for health care providers, has published a variety of useful resources for health care organizations.  The resources provide some excellent coverage and are useful for all providers who are facing the Coronavirus pandemic.  The Joint Commission says that its goal in creating the resource page is to support health care professionals and organizations on the front lines of the COVID-19 pandemic.  Perhaps the biggest highlight of general application is the Joint Commissions “Real Voices. Real Stories.”  The Real Voices includes stories from a variety of front-line health care workers. 

You can download a PDF file of “Real Voices. Real Stories” at the following link: Real Voices PDF Download

Some of the stories in the “Real Voices” section include coverage of a Joint Commission Life Safety Coach Surveyor  and an emergency department nurse at one of the largest hospitals in Chicago, among others.

The Joint Commission website includes a variety of other resources.   The Joint Commission does not have the largest list of resources.  Instead, the Joint Commission’s goal is to attempt to cut through the deluge of information on the COVID-19 virus and provide “only the information that best meets the needs of health care workers and leaders.”

Unnecessary Inpatient Admissions Results in Hospital DOJ Settlement

April 29th, 2020

By Fisher, JD, CHC, CCEP

Hospital Admissions Fraud Risk Area

Unnecessary Inpatient Admissions – Hospital Fraud Settlement.

An $18 million settlement was agreed by a hospital chain after allegations that claims were submitted to Medicare for patients who were admitted to an inpatient facility when they allegedly could have been treated on a less costly outpatient basis.  The government alleged that the hospital system billed Medicare for short-stay, inpatient procedures that should have been billed on a less costly outpatient basis.  The government also accused the hospital system of inflating reports to Medicare regarding the number of hours of outpatient observation care that was provided.

This is a fairly typical case where the allegation involved billing for services that were of a higher level than required by the patient.  In effect, the excess services are deemed to be medically unnecessary.  In this case, the services involved inpatient admissions that the government alleged could have been taken care of in a less costly outpatient setting.

A former employee was the whistleblower in the case and walks away with over $3.25 million from the settlement.

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The Joint Commission COVID-19 Information Page for Health Care Providers

April 29th, 2020

By John Fisher, JD, CHC, CCEP

The Joint Commission has issued a Coronavirus (COVID-19) guidance page for hospitals and other organizations who are accredited through that organization. The page contains a letter and a video from the CEO of the Joint Commission, Mark R. Chassin, MD, FACP, MPP, MPH.

The Joint Commission Offers Useful Resources on the COVID-19 Pandemic.

The page also contains a variety of statements from the Joint Commission, Frequently Asked Questions about the Joint Commission’s statement on use of face masks brought from home, a statement on universal masking, a public statement on the shortage of critical equipment.

The page contains an interesting section highlighting stories from health care workers who are working on the front lines of the battle against the virus.

The Joint Commission page contains topical coverage of a variety of COVID-19 issues that are being faced by health care providers. The Joint Commission offers some really good content. There are informative articles, videos, training material and a wide variety of resources related to the COVID-19 virus, organized by category.

Some of the information on the Joint Commission site includes:

  • Personal Protective Equipment (PPE)
  • Ventilator and Respiratory Support
  • Staffing andRead more here: Health Law Blog

      

Joint Commission COVID-19 Resources

April 29th, 2020

Joint Commission COVID-19The Joint Commission, one of the nation’s top accreditation organizations for health care providers, has published a variety of useful resources for health care organizations.  The resources provide some excellent coverage and are useful for all providers who are facing the Coronavirus pandemic.  The Joint Commission says that its goal in creating the resource page is to support health care professionals and organizations on the front lines of the COVID-19 pandemic.  Perhaps the biggest highlight of general application is the Joint Commissions “Real Voices. Real Stories.”  The Real Voices includes stories from a variety of front-line health care workers. 

You can download a PDF file of “Real Voices. Real Stories” at the following link: Real Voices PDF Download

Some of the stories in the “Real Voices” section include coverage of a Joint Commission Life Safety Coach Surveyor  and an emergency department nurse at one of the largest hospitals in Chicago, among others.

The Joint Commission website includes a variety of other resources.   The Joint Commission does not have the largest list of resources.  Instead, the Joint Commission’s goal is to attempt to cut through the deluge of information on the COVID-19 virus and provide “only the information that best meets the needs of health care workers and leaders.”

Whistleblower Settlements Increase Compliance Risk for Providers

April 23rd, 2020

By Fisher, JD, CHC, CCEP

Dermatology Risk Areas Fraud and Abuse

Recent Fraud Settlements Emphasize Risk of Whisttleblowers

One of the reasons why compliance officers and health care attorneys read fraud settlements is to identify the issues that the government is focused on.  The cases that the government decides to pursue are very indicative of the areas of fraud enforcement that they feel are important.  These are not the only issues that should be considered, but government enforcement actions certainly tell us what types of arrangements the government considers important.

The misfortune of the defendants involved in these cases hold a potential learning experience for everyone else.  Others have an opportunity to focus on their own operations to identify whether they are at risk in any of the areas involved in these cases.

An ancillary lesson that these settlements hold is that each was initially raised by a whistleblower.  The False Claims Act gives whistleblowers a portion of the settlement in cases where the government decides to intervene.  This in effect creates a universe of potential claimants that can include almost anyone with original knowledge of the alleged practice.

Common whistleblowers include former or disgruntled employees.  It really does not matter of the employee is or was the worst employee in the world, they can

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Telemedicine Services Furnished in a Hospital – Telehealth Staff Privileges and Distant Site Credentialing –

April 23rd, 2020

Telehealth Credentialing – Excerpts from the State Operations Manual A-0342

§482.22(a)(3) When telemedicine services are furnished to the hospital’s patients through an agreement with a distant-site hospital, the governing body of the hospital whose patients are receiving the telemedicine services may choose, in lieu of the requirements in paragraphs (a)(1) and (a)(2) of this section, to have its medical staff rely upon the credentialing and privileging decisions made by the distant-site hospital when making recommendations on privileges for the individual distant-site
physicians and practitioners providing such services, if the hospital’s governing body ensures, through its written agreement with the distant-site hospital, that all of the following provisions are met:
(i) The distant-site hospital providing the telemedicine services is a
Medicare-participating hospital.
(ii) The individual distant-site physician or practitioner is privileged at the distant site hospital providing the telemedicine services, which provides a current list of the distant-site physician’s or practitioner’s privileges at the distant-site hospital.
(iii) The individual distant-site physician or practitioner holds a license issued or recognized by the State in which the hospital whose patients are receiving the telemedicine services is located.
(iv) With respect to a distant-site physician or practitioner, who holds current privileges at the hospital whose patients are receiving the telemedicine services, the hospital has evidence of an internal review of the distant-site physician’s or practitioner’s performance of these privileges and sends the distant site hospital such performance information for use in the periodic appraisal of the distant-site physician or practitioner. At a minimum, this information must include all adverse events that result from the telemedicine services provided by the distant site physician or practitioner to the hospital’s patients and all complaints the hospital has received about the distant-site physician or practitioner.

Interpretive guidelines §482.22(a)(3)
The hospital’s governing body has the option, when considering granting privileges to telemedicine physicians and practitioners, to have the hospital’s medical staff rely upon the credentialing and privileging decisions of the distant-site hospital for these physicians and practitioners. This process would be in lieu of the traditional process required under
§482.22(a)(1) and §482.22(a)(2), whereby the hospital’s medical staff conducts its own review of each telemedicine physician’s or practitioner’s credentials and makes a recommendation based on that individualized review.
In order to exercise this alternative credentialing and privileging option, the hospital’s governing body must ensure through its written agreement with the distant-site hospital that all of the following requirements are met:


• The distant-site hospital participates in the Medicare program. If the distant-site hospital’s participation in Medicare is terminated, either voluntarily or involuntarily, at any time during the agreement, then, as of he effective date of the termination, the hospital may no longer receive telemedicine services under the agreement;
• The distant-site hospital provides to the hospital a list of all its physicians and practitioners covered by the agreement, including their privileges at he distant site hospital. The list may not include any physician or practitioner who does not hold privileges at the distant-site hospital. The list must be current, so the agreement must address how the distant-site hospital will keep the list current;
• Each physician or practitioner who provides telemedicine services to the hospital’s patients under the agreement holds a license issued or recognized by the State where the hospital (not the distant-site hospital) is located. States may have varying requirements as to whether they will recognize an out-of-state license for purposes of practicing within their State, and they may also vary as to whether they establish different standards for telemedicine services. The licensure requirements governing in the State where the hospital whose patients are receiving the telemedicine services is located must be satisfied, whatever they may be; and
• The hospital has evidence that it reviews the telemedicine services provided to its patients and provides feedback based on this review to the distant-site hospital for the latter’s use in its periodic appraisal of each physician and practitioner providing telemedicine services under the agreement. At a minimum, the hospital must review and send information to the distant-site hospital on all adverse events that result from a physician or practitioner’s provision of telemedicine services under the agreement and on all complaints it has received about a telemedicine physician or practitioner covered by the agreement.

Denial of Access to Deadbeat Patients

April 23rd, 2020

By Fisher, JD, CHC, CCEP

Private Practice Revises Access Procedure to Provide Access Despite an Outstanding Balance

A complainant alleged that a private practice physician denied her access to her medical records, because the complainant had an outstanding balance for services the physician had provided. During OCR’s investigation, the physician confirmed that the complainant was not given access to her medical record because of the outstanding balance. OCR provided technical assistance to the physician, explaining that, in general, the Privacy Rule requires that a covered entity provide an individual access to their medical record within 30 days of a request, regardless of whether or not the individual has a balance due. Once the physician learned that he could not withhold access until payment was made, the physician provided the complainant a copy of her medical record.

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Coronavirus Checklist for Nursing Homes and Hospitals

April 23rd, 2020

By John Fisher, JD, CHC, CCEP

Follow the links below to download from the CDC.

A coronavirus preparedness checklist for hospitals, including long-term acute care hospitals are available from the CDC.

Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings:

Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities (LTCF):

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When is a Referral Mandate for Employed Physicians Permitted under the Stark Law?

April 23rd, 2020

By Fisher, JD, CHC, CCEP

Referral Requirements Employed Physicians

When Employed Physicians be Required to Make Referrals for Designated Health Services

The Stark Law Regulations include a provision that dictates the conditions under which an employer of a physician may mandate referrals for designated health services. Certain specific conditions must be met if an employer wishes to require its employed physicians to make referrals to the employer’s designated health services. Many institutions assume that an employer may always require an employed physician to make referrals to its ancillary services. That assumption is not correct.

The Stark regulations provides that a physician’s compensation from a bona fide employer or under a managed care contract or other contract for personal services may be conditioned on the physician’s referrals to a particular provider, practitioner, or supplier. There are a number of specific requirements that must be present to permit referral requirements including:

  1. The required referrals can only relate to the physician’s services covered by the scope of the employment or the contract.
  2. The referral requirement must be reasonably necessary to effectuate the legitimate business purposes of the compensation arrangement.
  3. The physician’s compensation must be set in advance for the term of the agreement requiring referrals.
  4. The physician’s compensation must beRead more here: Health Law Blog

      

Complying with HIPAA and Beyond during COVID-19

April 23rd, 2020

By John Fisher, JD, CHC, CCEP

Safeguarding Patient Health Information in an Emergency Situation

Even in an emergency situation such as that presented by the COVID-19 pandemic, covered entities must continue to meet their obligations under federal and state laws protecting confidentiality of patient health care information, to implement reasonable safeguards to protect patient information against intentional or unintentional impermissible uses and disclosures. They must continue to comply with the administrative, physical, and technical safeguards of the security rule and privacy rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Covered Entities must continue to comply with HIPAA and other confidentiality laws during the COVID-19 pandemic. Certain emergency provisions may apply in applicable state and federal regulations.

The obligation to conduct periodic HIPAA security assessments continues, even during the existence of an emergency or natural disaster. The obligation to meet the requirements of state laws protecting special status health information such as mental health records and drug and alcohol rehabilitation records, also continues through a pandemic.

Each of the bodies of regulations that apply to patient health information contain certain specific provisions that can apply during a pandemic. For example, HIPAA permits disclosures to public health authorities and others

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