First Healthcare Compliance CONNECT May 2020

CONNECT
May 2020
A Monthly Publication for the Healthcare Compliance Community
Q&A: Compliant Coding and
Billing For TeleHealth During
COVID-19
Speaker Highlight: Navigating
the Background Check & FCRA
Compliance Minefield
Understand CMS Changes
to Compliance Training for
Healthcare Providers under
Medicare Advantage and
Part D
1st Talk Compliance: New HHS
Rules, PHI, and Health Apps in
the Age of COVID-19
Upcoming and On-Demand
Webinars
FAQ Corner
New Ebook: COVID-19 Healthcare
Compliance Updates

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In This Issue:
FAQ Corner
Q&A: Compliant Coding and Billing For TeleHealth During COVID-19
Speaker Highlight: Navigating the Background Check & FCRA Compliance Minefield
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Compliance Super Ninja
Marie Stinson
Office Manager at Providence Pediatrics
Client of our Private Practice Solution since 2018
COVID-19 Healthcare
Compliance Updates
MAY
2020
In response to the global outbreak of the novel coronavirus disease
(COVID-19), the Secretary of Health and Human Services
declared a public health emergency on January 31, 2020.
Federal agencies have taken action by issuing updates
and guidance to navigate the crisis.
This ebook provides healthcare providers with important developments
and resources that impact federal healthcare laws.
DOWNLOAD NOW
Understand CMS Changes to Compliance Training for
Healthcare Providers under Medicare Advantage and Part D
1st Talk Compliance: New HHS Rules, PHI, and Health Apps
in the Age of COVID-19
Upcoming and On-Demand Webinars
Contact Toll Free: 888-54-FIRST 3

FAQ Corner
How does the Families First Coronavirus Response Act Impact
Healthcare Providers?
On March 18, 2020, the Families First Coronavirus Response Act (FFCRA) was signed into law in response to
COVID-19, and took effect on April 1, 2020. The FFCRA provides paid leave to eligible employees through the
creation of the Emergency Paid Sick Leave Act (EPSLA) and the Emergency Family and Medical Leave Expansion
Act (EFMLA). Employers may exclude health care providers and emergency responders from the FFCRA and the
Department of Labor (DOL) has issued guidance defining these terms broadly.
Health Care Provider Exemption
For purposes of exempting employees from coverage under FFCRA, a health care provider is defined as anyone
employed at any of the following entities:
• doctor’s office
• hospital
• health care center
• clinic
• post-secondary educational institution offering health care
instruction
• medical school
• local health department or agency
• nursing facility
• retirement facility
• nursing home
• home health care provider
• any facility that performs laboratory or medical testing
• pharmacy
• any similar institution, employer, or entity (this includes any permanent or temporary institution, facility, location,
or site where medical services are provided that are similar to such institutions)
• individuals employed by an entity that contracts with any of the listed entities to provide services or to maintain
the operation of the facility; this also includes employees of any entities that provide medical services, produces
medical products, or is otherwise involved in the making of COVID-19 related medical equipment, tests, drugs,
vaccines, diagnostic vehicles, or treatments
• any individual that the highest official of a state, the District of Columbia, or a territory determines is a health
care provider necessary for its response to COVID-19
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Emergency Responder Exemption
For purposes of exempting employees from coverage under FFCRA, an emergency responder is defined as anyone
who is necessary for the provision of transport, care, health care, comfort, and nutrition of patients, or others needed
for the response to COVID-19. This includes, but is not limited to:
• emergency medical services personnel
• physicians
• nurses
• public health personnel
• emergency medical technicians, paramedics
• emergency management personnel
• military or national guard, law enforcement officers, correctional institution personnel, fire fighters, 911
operators, child welfare workers and service providers, public works personnel
• any individual whom the highest official of a State or territory, including the District of Columbia, determines
is an emergency responder necessary for that State’s or territory’s or the District of Columbia’s response to
COVID-19
In order to minimize the spread of COVID-19, the DOL encourages employers to be judicious when deciding whether
to exempt health care providers and emergency responders from FFCRA. For example, DOL notes that an employer
may decide to exempt these employees from leave for caring for a family member, but choose to provide them paid
sick leave in the case of their own COVID-19 illness.
Explore the FAQs tab in your compliance solution
to find answers to your compliance questions!
CLIENT
ALERT
Navigating Workplace Violence
Prevention Under OSHA
Workplace violence is a serious issue, especially in healthcare facilities. In 2013
alone, over 25,000 occupational assault injuries occurred, most of which were
in the health care and social services industries. The Occupational Safety and
Health Administration (OSHA) responded in 2015 by updating and publishing
their guidelines on how to best prevent workplace violence. The OSHA workplace
violence prevention guidelines help employees and employers alike by providing
the necessary steps to maintain a safe work environment.
DOWNLOAD NOW
Contact Toll Free: 888-54-FIRST 5

Q&A: Compliant Coding and Billing
For TeleHealth During COVID-19
By Catherine Short
Sonal Patel, Health Care Coder and
Compliance Consultant for Nexsen
Pruet, recently presented the webinar
“Compliant Coding & Billing For
TeleHealth During COVID-19” which
can now be viewed here. Sonal
returned to answer many commonly
asked questions in relation to this
presentation.
When are these codes good for billing purposes
during this pandemic and do you recommend I
hold my claims?
According to the April 6, 2020 published Interim Final Rule,
the applicability date for these regulations is March 1, 2020.
So yes, I hope you have held claims since then because
there has been so much confusion due to misinformation,
as well as conflicting information during these past few
weeks. I would advise understanding your practice’s
payor mix and their policies on telehealth. There are also
vast differences in commercial payor guidelines so you
must perform your due diligence and research. Medicaid
individual state policies also need to be understood before
proper coding and billing can occur.
Do you know if CMS will have audits later?
Post-payment audits post-Covid-19 most certainly will
occur. Certain elements of telehealth, virtual check-ins, and
e-visits may be waived temporarily and CMS has stated
they will not be auditing those specific elements, but
everything else is up for review. This unprecedented time
in our history has opened up telehealth to everyone and
auditors still need to be mindful of fraud, waste, and abuse.
What is HIPAA compliant in normal times for
telehealth technologies?
Applications for smartphones, iPads, iPads, laptops,
desktops that are HIPAA compliant without the imposition
of a global-now-national pandemic like COVID-19, include
items you may need to purchase like Skype Business.
Microsoft does give physicians a Business Associate
Agreement (BAA) if they want to use this HIPAA-compliant
platform. However, patients must also have an Office365
account linked to the cloud-based Skype Business service.
Can you tell us about any hospital waivers or
relaxations for telehealth services in those
locations?
Although my webinar focused on Medicare Part B, there
are certainly waivers and relaxations that were recently
released on March 30, 2020 for Medicare Part A. These
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allow hospitals and healthcare systems to deliver services
at other community-based locations to make room for
COVID-19 patients needing acute care in their main
facilities. The changes complement and augment the
work of the Federal Emergency Management Agency
(FEMA) and state and local public health authorities by
empowering hospitals and healthcare systems to rapidly
expand treatment capacity and separate infected from
uninfected patients. CMS’s waivers and flexibilities will
permit patients to be triaged to a variety of communitybased
locales, including ambulatory surgery centers,
inpatient rehabilitation hospitals, hotels, and dormitories.
Transferring uninfected patients will help hospital staff to
focus on the most critical COVID-19 patients, maintain
infection control protocols, and conserve personal
protective equipment (PPE).
Be sure to view a replay of Sonal’s webinar Compliant
Coding & Billing For TeleHealth During COVID-19. Be sure
to also check out our other COVID-19 webinars on this
blog article as well as our on-demand webinars in our
shopping cart as part of our online compliance training
courses.
Sonal Patel CPMA, CPC, CMC, ICD-10-CM is a healthcare
coding and compliance consultant at the law firm of
Nexsen Pruett, LLC. She has over 10 years of experience
in multi-specialty healthcare coding and auditing. She
provides reimbursement investigations for both Parts A
and B providers. Patel provides healthcare lawyers with
strategies and analyses to overturn denials with private
and government payors.
HIPAA Privacy and Security
This book provides an easy-to-understand
overview of HIPAA and how it impacts
healthcare companies and their employees.
BUY BOOK NOW
Contact Toll Free: 888-54-FIRST 7

Speaker Highlight: Navigating
the Background Check & FCRA
Compliance Minefield
By Catherine Short
Catherine Walters, Partner at Bybel
Rutledge LLP led the presentation,
Navigating the Background Check
and FCRA Compliance Minefield at the
Healthcare Compliance Symposium 2020
on April 23, 2020.
Catherine E. Walters provides exclusive management-side
labor and employment services for employers of all sizes,
including privately and publicly held companies, government
contractors, institutions of higher education, health
care providers, trade associations and other non-profit
organizations.
She focuses on identifying current and emerging trends in
order to provide clients with proactive legal advice aimed at
managing and preventing emerging risks.
Her emphasis on strategic thinking and focused solutions
enables her to provide employers with the sophisticated
counsel that has become necessary in today’s complex
business environment. Catherine regularly appears before
federal and state courts and administrative agencies where
she handles both employment and traditional labor matters.
Her practice spans an array of industries, including financial
and banking, manufacturing, defense contracting, education,
health care, professional services, insurance, construction,
technology, retail, real estate, transportation, restaurant and
hospitality.
Catherine’s extensive experience and collaborative skills
enable her to partner with her clients to develop creative,
practical, business-oriented solutions to their legal
challenges.
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The most comprehensive
healthcare compliance course
The Fundamentals is a user-friendly, four-module online course designed to help healthcare professionals
understand the essential principles and practices of compliance.
Written by our “dream team” of healthcare providers and attorneys, The Fundamentals course is packed
with useful, easy-to-understand information that covers HIPAA, OSHA, employment law and enforcement of
federal healthcare laws.
The course takes less than four hours to complete, and the modules can be viewed in any order. A certificate
of course completion is provided following successful completion of the online course and exam.
The Compliance Certification Board (CCB)® has approved this event for up to 4.0 nonlive CCB CEUs. Continuing
Education Units are awarded based on individual attendance records. Granting of prior approval in no way
constitutes endorsement by CCB of this event content or of the event sponsor.
Buy Course Today
Contact Toll Free: 888-54-FIRST 9

Understand CMS
Changes to Compliance
Training for Healthcare
Providers under Medicare
Advantage and Part D
By Sheba Vine, JD, CPCO
Establishing and maintaining a well-designed compliance
program is key to preventing, detecting, and mitigating
noncompliance. The seven elements of an effective
compliance program outlined in the Federal Sentencing
Guidelines, sets the framework but there are additional
requirements that need to be integrated into the
compliance program in order to be effective. The Centers
for Medicare & Medicaid Services (“CMS”) requires
Medicare Advantage (Part C) plan sponsors and Medicare
Prescription Drug (Part D) plan sponsors to follow certain
compliance program requirements as part of their
contract. Plan sponsors are responsible for ensuring First
Tier, Downstream and Related Entities (FDR), such as
participating healthcare providers, also comply with these
program requirements.
• First Tier Entity – A party that enters into a written
arrangement with a Medicare Advantage Organization
or Part D plan sponsor or applicant to provide
administrative services or health care services to a
Medicare-eligible individual.
• Downstream Entity – A party that enters into a
written arrangement with a First Tier entity for the
provision of administrative services or health care
services to a Medicare eligible individual.
• Related Entity – An entity that is related to a
Medicare Advantage Organization or Part D sponsor
by common ownership or control and 1) performs
management functions under contract or delegation,
2) furnishes services to Medicare enrollees under
an oral or written agreement, or 3) leases real
property or sells materials to the Medicare Advantage
Organization or Part D plan sponsor at a cost of more
than $2,500 during a contract period.
As a result of the FDR relationship, many healthcare
providers must submit attestations and/or certifications of
compliance to their third-party payors as evidence of their
compliance efforts. However, as of January 1, 2019, CMS
updated its compliance requirements to no longer require
healthcare providers participating in Medicare Advantage
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First Healthcare Compliance, LLC © 2020

and Part D to complete CMS issued web-based general
compliance training and fraud, waste, and abuse training.
This change arises from providers being subjected to
multiple plan sponsors training program requirements,
creating administrative burden and inefficiencies in the
compliance program training and education element.
According to CMS “[plan sponsor] compliance programs
are very well established and have grown more
sophisticated since their inception,” allowing them to
remove this requirement.
Plan sponsors are still required to develop an effective
oversight structure for their FDRs and must continue to
monitor and audit FDRs. While CMS removed the use
of CMS developed training requirements, plan sponsors
have discretion to include their own compliance program
training requirement as part of their contracts with
FDRs. Therefore, FDRs, such as healthcare providers,
must review their plan sponsor contracts to determine if
they must continue using CMS training materials or are
subject to modified compliance training requirements. For
healthcare providers that continue to use CMS training
materials, note that CMS updated its general compliance
and fraud, waste, and abuse web-based online courses
within its Medical Learning Network as of April 2020.
Incorporating appropriate software tools into your
compliance strategy will help streamline processes
and serve as your first line of defense against these
significant risks areas. First Healthcare Compliance’s
cloud-based software offers solutions to fit your
organization. Contact us today for a quick demonstration
of our compliance management software solution.
Contact Toll Free: 888-54-FIRST 11

hosted by Catherine Short
Catherine Short converses with Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C.,
Houston, TX, on the topic of “New HHS Rules, PHI, and Health Apps in the Age of COVID-19.” On March 9, 2020,
HHS announced the promulgation of two final rules – the ONC Final Rule and the CMS Final Rule. The purpose is to
expand an individual patient’s control over their health data. It requires insurance plans to share health data with their
patients in a format suitable for their phones or other device of choice. How does this impact provider liability in light of
the Healthcare Apps Guidance issued by HHS? During this program, Rachel will explain the two new final rules, as well
as the potential impact on providers; review the Healthcare Apps Guidance, which relates to HIPAA liability; and provide
suggestions for integrating the new rules while continuing to strive towards HIPAA compliance.
Listen weekdays at
7:30am, 3:30pm, 11:30pm ET
Check out our Show Page!
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N A X S P M E C N E I R E P X E L K T K
J M C G T X C G E V W T N A I L P M O C
L L O C B Z P F R R M I K J D N P G Q Z
A V R A Z H F U F M T K N E Q Q H L M A
Q R O E T R W M W G T I F S R C B U L U
Z V N E R N N M U Y N E F Q U Z X N B J
E W A U V A Q Q J S E G U I G R R W Q Q
V J V X C I C R B B I N U M C E A V P C
M Y I Y M B S H M N T K Q N M A T N I O
E R R Q B R B N T O A X J E M X T M C W
D X U O R B G D E L P S R G W H E I V E
I B S W T S I T M H A G L M A D M K O C
C Y R T F A F L H U E E V H N K V V W N
A S K N C T R Q Y N A R H A Y G K Y J A
R K Q I G X A O C E F C P L D Z X B D D
E S D Y D M F Y B T B P T M W L N G O I
B E O U W J D P E A B L F O O T A W A U
M W A J K M N K G S L G H J U C O T V G
B K A I V O N H P I C M P K B S V J U M
CORONAVIRUS HEALTHCARE LABORATORY
COMPLIANT TELEHEALTH PANDEMIC
MEDICAID MEDICARE EMERGENCY
INSURANCE COMPREHENSIVE EXPERIENCE
CERTIFICATION GUIDANCE PATIENT
Contact Toll Free: 888-54-FIRST 13

Upcoming and On-Demand Webinars
Training
MAY 27, 2020 Medical Debt: The Good, The Bad and The Ugly Register
ON DEMAND:
ON DEMAND:
ON DEMAND:
ON DEMAND:
HHS Final Rules, Patient Access to PHI & Health Apps Intersect
Aerosol Transmissible Disease Standard (ATD) using California
Standards as a Model
Funding in the Time of COVID-19
Compliant Coding & Billing For TeleHealth During COVID-19
Full Webinar List
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