All employers with more than 100 employees will have to begin monitoring vaccination status next month, under the new regulations.
Starting Dec. 4, all employers with more than 100 employees (except those already covered under federal contractor and healthcare rules) must learn the vaccination status of all their employees. Those employees who are unvaccinated must provide a negative test result at least every seven days, and wear a face covering at work. The Occupational Safety and Health Administration (OSHA) published its emergency temporary standard (ETS) on this matter last week. Employers must comply with most provisions of the ETS by Dec. 4, and implement the testing requirements by Jan. 3, 2022.
I am certain that this will face many legal challenges in the next few weeks, but I wanted to prepare you for contingencies. I anticipate that we will be receiving lots of questions about this over the next few days.
Going to the topic of Recovery Audit Contractors (RACs), we need congressional action to protect providers from premature recoupment during the Medicare appeals process between levels 1 and 2. As we all know, appealing an alleged Medicare overpayment stays any premature and erroneous recoupment through levels 1 and 2. Level 3 is the administrative law judge (ALJ) level, and the first time you can present evidence and examine witnesses. In order to prevent recoupment between levels 2 and 3, providers must file injunctions enjoining the recoupment. The argument is that irreparable harm will occur by recouping, say, $7 million, and that the audit is faulty. Across the country, the courts are split as to whether to prevent premature recoupment. Until this new case, the 5th Circuit was on the provider’s side, saying you cannot recoup funds until you prove they are owed. There is a 90-percent overturn rate at the ALJ level.
In the newest case, Family Innovations underwent a scathing Unified Program Integrity Contractor (UPIC) audit. It was accused of owing over $7 million. The company provides home healthcare to Medicare patients in Texas. The accusation is that the clients were not “homebound,” which is false. The company’s legal team was successful at obtaining an injunction at the Superior Court level, but a couple weeks ago, the 5th Circuit overturned the lower court ruling and recoupment began.
The 5th Circuit took the opposite position in 2018 in Family Rehab., Inc. v. Azar. In that case, the Court went so far as to call the Medicare provider appeal process “the harrowing labyrinth of Medicare appeals.” That panel understood the sheer mess of an appeals process we have for providers, and that Medicare providers have a protected property interest in reimbursements for services rendered. The 5th Circuit itself is split on the issue of a property interest, and so too are the other circuit courts across the country. The 4th Circuit upholds the property interest. We either need a Supreme Court decision on the issue or congressional action. Right now, the issue is a ping-pong ball challenge.
Programming Note: Listen to Knicole Emanuel’s live RAC Report every Monday on Monitor Mondays, 10 Eastern.
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The recent UnitedHealthcare hack has left providers and payers in shock. In an era when digital information flows ceaselessly across the Internet, the protection of
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Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
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Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
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During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
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