August RAC Report Recap | Knicole Emanuel

Practus LLPLegal Insights

RAC Report logo on image of healthcare provider at computer for telehealth

A RAC Report Roundup of Healthcare Law Updates

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Weekly Panelist & Practus Partner, Knicole Emanuel, Runs the RAC Report Segment on RACmonitor’s, Monitor Mondays Podcast.

Healthcare industry expert and Practus partner, Knicole Emanuel, is a regular contributor to the healthcare industry podcast, Monitor Mondays, by RACmonitor. In this article we break down the important changes that have taken place since the public health emergency (PHE) was declared. 

Featured August RAC Report Summaries

  • Telehealth and Medicaid Expansion During COVID
  • Medicare Audits Target COVID-19-Enhanced Reimbursement Rates and Remote Patient Monitoring
  • Medicare Exceptions Abound In Time of COVID-19, Prepare for Following Recessions
  • CMS Ends Suspension of Most Medicare Fee-For-Service Reviews , Stresses It Will Minimize Provider Burdens

Read below to learn more about what you need to know as an industry insider. Be sure to tune into the RAC Report on Monitor Monday’s every week as well!

Telehealth and Medicaid Expansion During COVID

With the global health crisis turning social distancing practices into a necessity, the United States has seen a surge in use of telehealth appointments and Medicaid expansion. Knicole Emanuel notes that providers are seeing more patients and patients have more options of care. Along with these new methods of care come the additional likelihood of Recovery Audit Contractor (RAC) and Medicare Administrative Contractor (MAC) audits. 

The coronavirus has spurred an influx of new Medicaid qualifiers without expansion. Three states, Missouri, Oklahoma and Nebraska, however, all recently voted to expand the program but have not effectively implemented these changes to date. The rise in Medicaid qualification shows no sign of slowing down as the virus continues to remain rampant, with persistent high unemployment rates and loss of employer health benefits. 

The virus also has revealed a multitude of inequalities, including income disparities, joblessness, and financial hardships faced by numerous hospital systems. Not all states are following suit with approval of Medicaid expansion programs but that will not change the need of many to be qualified for the program.

Lastly, as patient healthcare needs increase, the rise in telehealth is commonly being popularized. From the latest data of primary care visits, more than 40% were telehealth appointments during the shut down. Medicare even temporarily waived restrictions providing anyone access to this service. 

To ensure permanent access would require passing of legislation but bi-partisan interest appears to be present. Knicole does caution that the rise of telehealth will most likely contribute to an increase in RAC and MAC auditing. Specifically, if a change in cost parity of telehealth vs in-person visits occurs, providers should prepare for increased use of audits.

To Listen to the Full August Podcast Episode Checkout:

Monitor Mondays | Season 10, Episode33: Exclusive: The Healthcare Algorithms Arms Race is Heating Up

Air Date: August 31, 2020

Hands signing off on audit document

Medicare Audits Target COVID-19-Enhanced Reimbursement Rates and Remote Patient Monitoring

COVID-19 continues to place additional program integrity pressures within CMS (Centers for Medicare & Medicaid Services). Recovery Audit Contractor (RAC) and Medicare Administrative Contractor (MAC) audits are expected to continue at a high level of scrutiny as the ongoing public health emergency (PHE) manufactures a high concentration of reimbursement claims. 

Areas of particular focus include post-payment reviews of COVID-19 tests and remote patient monitoring (RPM) codes occurring prior to March 1, 2020. Knicole warns providers, however, to be prepared for the inevitable audits that will be conducted for claims taking place during the PHE.

While the pandemic has provoked numerous disruptions, it’s also generated a positive industry shift in the use of remote auditing software tools. Previous on-site audit fieldwork groups are now meeting virtually with video conferencing and video tools. While Knicole notes testing on the efficacy and veracity of these remote auditing tools are yet to be completed, she’s hopeful this trend of work continues. 

Some reasons why remote auditing tools are in demand: 

  • Improved social distancing practices
  • Ease in document organization
  • Decreased disruptions for consumer care and providers
  • Digitization of document tracking and record keeping

As telehealth and remote patient care are on the rise, it will be important for providers to make detailed notes within medical records and submit claims under the proper coding designations. For example, periods of care lasting less than 16 days but more than 2 will be accepted in a particular grouping of codes. Patient claims with a suspected or confirmed COVID-19 diagnosis, however, will fall under a separate code designation. 

Knicole Emanuel suspects remote physiologic monitoring will be a hot topic and encourages providers to keep accurate and detailed records for the type of remote care performed. Increased medical record transparency will likely result in higher reimbursement approval success rates.

To Listen to the Full RAC Report Checkout:

Monitor Mondays | Season 10, Episode 32: Big Pharma versus 340B

Air Date: August 24, 2020

healthcare professionals walking in all with their backs toward the camera

Medicare Exceptions Abound In Time of COVID-19, Prepare for Following Recissions

In this RAC Report episode, Knicole Emanuel calls attention to the numerous Executive Orders by President Trump relating to Medicare exceptions in our current public health emergency. These temporary regulatory waivers are intended to equip the healthcare industry with maximum flexibility in responding to the needs of the pandemic. Many apply to SNFs (Skilled Nursing Facilities). However, once inevitable recessions begin to take place, we can expect RAC and MAC auditing to target these exceptions. 

With internet access now as necessary as owning a car, Knicole actually recommends turning to Google as a useful guide. Not to discount the importance of an attorney, should one be needed, groups like SNFs may use the web’s array of resources as they navigate these exceptions and the process to follow as they rescind. This can help them prepare and head off any looming RAC and MAC audits. 

The three main exceptions for SNFs to be aware of are:

  • Three day hospitalization
  • Accelerated payments or advanced payments for cash flow in the Medicare appeals
  • Medicare appeals and fee for service, Medicare Advantage in Part D. 

To read more about the flurry of Executive Orders that have been pushed through, Knicole’s RACMonitor co-panelist, Matthew Albright provides an in depth breakdown in his article

Additionally, be sure to listen to Emanuel’s live webinar on September 29th to hear more details about the exceptions Skilled Nursing Facilities should be aware of.

To Listen to the Full Podcast Episode Checkout:

Monitor Mondays | Season 10, Episode 31: California Whistleblower Claim Yields $24 Million AbbVie Settlement

Air Date: August 17, 2020

CMS Ends Suspension of Most Medicare Fee-For-Service Reviews, Stresses It Will Minimize Provider Burdens

With the public health emergency in full swing, health providers are voicing concern and displeasure at the recent announcement of CMS ending the suspension of most medicare fee-for-service medical reviews. It was stated that facilities should expect audits to resume, specifically regarding the 50 billion in provider relief funds (PRF) that were distributed to hospitals and other providers. 

The Office of Inspector General (OIG) will audit to determine the means of calculation and compliance with PRF payment disbursement. Providers will have to submit any report requested and Health and Human Services (HHS) will notify them of the content and due date. Recipients of funds will also be required to submit future reports related to the use of this relief money. 

Some stressors include the difficulties that arose based on how much relief providers and hospitals should request and who received what percentage of the funds. However, providers that used the growth revenue worksheet – Form 1.0 – should be given some assumption that their reports are accurate. 

Knicole notes that PPE (Personal Protection Equipment) audits may not resume as quickly but CMS has signaled Post-Pay Review audits will begin shortly, a generally less invasive review. Medicare audits will start on a state-by-state basis. As a reminder, Knicole stresses that Medicare Administrative Contractors should be contacted should a facility need more time in responding to audit requests. There should be some flexibility in when information is due for the audit process, should one be requested. 

To Listen to the Full RAC Report & Episode Checkout:

Monitor Mondays | Season 10, Episode 30: Exclusive 60-Minute Broadcast: COVID-19 Rules

Air Date: August 10, 2020

Healthcare Law Attorney Knicole Emanuel

About Knicole C. Emanuel, Esq.

For more than 20 years, Practus Partner, Knicole Emanuel, has maintained a healthcare litigation practice, concentrating on Medicare and Medicaid litigation, healthcare regulatory compliance, administrative law and regulatory law. Knicole has tried over 2,000 administrative cases in over 30 states and has appeared before multiple states’ medical boards. She has successfully obtained federal injunctions in numerous states. This allowed healthcare providers to remain in business despite the state or federal laws allegations of healthcare fraud, abhorrent billings, and data mining.

Knicole frequently lectures across the country on healthcare law. This includes the impact of the Affordable Care Act and regulatory compliance for providers, including physicians, home health & hospice, dentists, chiropractors, hospitals and durable medical equipment providers. Knicole is a member of the RACmonitor editorial board and a popular panelist (for the RAC Report) on the healthcare industry-related podcast, Monitor Mondays.