Did you see that CMS updated the Provider Enrollment FAQ in July affecting several flexibilities for DME suppliers? They modified:

• Question 20 (accreditation and re-accreditation).
• Question 21 (supplier standards 7, 9, and 30 for physical facility, business telephone, and minimum hours, respectively).
• Question 22 (site visits).

Accreditation and Re-Accreditation Resume

On August 21, 2020, the NSC resumed enforcement for new and re-accreditation survey applications. Moreover, the agency is notifying suppliers that received extensions at the onset of the public health emergency (PHE) they have 30 days (from the date of the notice) to submit required documentation and resume the process. Those suppliers enrolled during the waiver period can expect to hear soon of rescheduled deadlines to produce documentation. Suppliers that do not comply risk loss of billing privileges.

Site Visits Resume

On August 6, 2020, the NSC announced it resumed site visits in accordance with the expiration of the standard 7 waiver. Standard 7 requires suppliers to occupy an appropriate site and post hours of operation.

Suppliers should ensure they:

• Post accurate hours of operation visible to the public and site inspectors.
• Take care to answer the business telephone during those hours.

Failure to do so could result in PTAN revocation.

Continued Waivers for On-Site Business Phone and Minimum Hours of Operation

Question 21 of the CMS FAQ contains incorrect information related to the enforcement of Standard 9 (primary on-site business phone, e.g. not a mobile or forwarded number) and Standard 30 (minimum hours of operation). The answer prematurely suggests CMS expired this waiver, when in-fact, the NSC continues to waive standards 9 and 30 for new and existing suppliers. As of this publication date, the CMS FAQ remains uncorrected.

Public Access Expectations Under Active Waivers

Despite continuation of the waivers for standards 9 and 30, the NSC expects suppliers to staff business phone lines during normal business hours. While the waivers persist, suppliers can forward calls to a remote office or cell phone, if necessary. As for retail hours open to the public, the NSC will not penalize locations with limited hours while waiver protection remains in force. Nonetheless, suppliers’ posted hours of operation should accurately reflect any temporary changes for the location.

Watch for Enforcement Changes

CMS continues to phase out waivers and flexibilities when the agency believes the climate no longer necessitates them. As such, suppliers should subscribe to NSC newsletters and check the NSC website for updated news on enforcement actions and waiver termination dates. We encourage suppliers to monitor conditions and self-impose a return to normal when feasible for each of their locations. When suppliers proactively phase out their reliance on waivers, they experience less disruption when the contractor announces a termination date. 

SOURCE LINKS
https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf
https://palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~National%20Supplier%20Clearinghouse~Articles~General~BS8KN64417?open
https://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/BSPMJP5722?opendocument
newsletters
https://palmettogba.com/palmetto/providers.nsf/News_New?OpenView&RestrictToCategory=National%20Supplier%20Clearinghouse

Suppliers may be surprised to learn that within weeks of launching the Paycheck Protection Program, the Department of Justice (the DOJ) filed its first criminal charges against applicants for such offenses as making false statements to a financial institution and bank fraud. In fact, the DOJ announced 25 separate PPP fraud cases totaling nearly $120 million between May 5 and August 21.

Sure, everyone expects the DOJ to pursue the most nefarious offenders. In many of these cases, applicants petitioned funds for fake or inactive companies. In others, they misappropriated funds for cars, jewelry, personal entertainment, and real estate. In all cases, the DOJ is questioning the legitimacy of the business or alleging misuse of funds.

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Why Should Suppliers Care?

While most suppliers used funds for legitimate businesses and actual employees – not Rolexes, Lamborghinis, and golf trips – many legitimate borrowers may have used funds inadvertently for unauthorized purposes. For example, the DOJ is alleging in one case that transfers from a borrowing company to a personal brokerage account for “personal benefit” constitutes fraud. Fraud issues aside, the ambiguous definition of personal benefit puts all payments to owners from borrowing companies in dangerous territory.

Strings Attached

Like it or not, the government is going to have an opinion on how companies use borrowed funds. Suppliers can avoid trouble by matching every incoming PPP dollar to an outgoing PPP-eligible expense. And before authorizing management bonuses or big investments, ask “Would this have been a good idea if we didn’t receive stimulus money to cover our payroll?”

SOURCE LINKS
https://www.justice.gov/news?keys=PPP&items_per_page=50
https://www.justice.gov/opa/pr/washington-tech-executive-charged-covid-relief-fraud-and-money-laundering

Recognizing the wisdom of CDC advice to limit all in-person, face-to-face contact, CMS waived requirements for in-person encounters included in NCDs, LCDs, and policy articles for the duration of the public health emergency (PHE). The waiver does not, however, mean Medicare will pay for products and services that are not medically necessary. The distinction continues to confuse many patients, practitioners, and suppliers.

Even during the PHE, the medical records for every DME item still require some form of support for medical necessity. Practitioners need to observe, monitor, and survey patients to the fullest extent possible. When in-person encounters are not practical, medical practitioners should substitute virtual visits wherever possible.

Minimum Requirements

The DME MACs summarize nicely in a joint article the minimum criteria to support claims submitted during the PHE. To pass future audits, supplier records need to:

• Contain a compliant standard written order (SWO).
• Establish services are reasonable and necessary.
• Support medical necessity, continued medical need, proof of delivery, and correct coding.
• For powered mobility devices (PMDs) and therapeutic shoes, document the practitioner performed an in-person or telehealth visit no more than six months prior to ordering.

Suppliers can rely on alternative records, including:

• Nurses’ notes.
• Home health assessments.
• Transcribed phone calls between the practitioner and the patient.

PMDs and Therapeutic Shoes

Federal law mandates a documented face-to-face visit for powered mobility and therapeutic shoes. The IFRs cannot suspend or override these federal mandates, so suppliers must ensure the treating practitioner documents either an in-person or a virtual telehealth visit before delivering either product type.

Suppliers can actively initiate and control many of these required variables. While suppliers must continue to request spontaneous medical records created by outside healthcare practitioners, CMS’s temporary waiver of in-person encounters allows suppliers to provide service to beneficiaries safely by using a wider range of medical records to support services during the PHE. 

SOURCE LINKS
https://cgsmedicare.com/jc/pubs/news/2020/06/cope17942.html
https://www.govinfo.gov/content/pkg/FR-2020-04-06/pdf/2020-06990.pdf
https://cgsmedicare.com/jc/pubs/news/2020/05/cope17333.html

In a joint DME MAC article on public health emergency (PHE) protocols published a while back, contractors instructed suppliers to bypass the:

• Certificate of Medical Necessity (CMN) attachment for select oxygen claims.
• DME MAC Information Form (DIF) attachment for select external infusion pump claims.

MiraVista does not interpret this exception to apply to every oxygen or infusion claim. Suppliers should only bypass attachment requirements during the PHE when the circumstances render the forms inapplicable.

The DME MAC article on PHE protocols contemplates the impact of document deficiencies that arise from setups during the PHE. Under the relaxed guidelines, it is probable that questions on these forms do not apply or otherwise disqualify a beneficiary under normal circumstances. To avoid claim processing complications, the DME MACs decided to forego the attachments entirely for affected claims.

When suppliers qualify oxygen or external infusion pump patients using relaxed baseline criteria and known deficiencies exist, suppliers should release the claims without a CMN or DIF form attachment. These claims should also contain an appropriately applied CR modifier and a COVID-19 narrative.

SOURCE LINKS
https://cgsmedicare.com/jc/pubs/news/2020/05/cope17333.html