Healthcare Faces Increased Scrutiny

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Healthcare faces increased scrutiny by governmental agencies

Healthcare faces increased scrutiny with a DOJ complaint alleging that an assisted living operator and 17 of his related corporate entities had “engaged in a multi-million dollar scheme” since 2016 and “knowingly billed Medicare for visits with facility residents that were not medically necessary, did not meet the requirements of the billing codes, or were not performed at all.” Read the whole story >>

The healthcare industry, particularly post-acute care, hospice, and therapies, is facing increased scrutiny from the Centers for Medicare and Medicaid Services (CMS) and other governmental agencies. Complying with audit and survey requests can place demands on already stretched human and financial resources. Excelas, LLC works to support the regulatory audit and survey process with services geared toward ensuring an expedient and complete response to the challenges at hand.


Enforceability of Arbitration Agreements in Long-Term Care

Recent court cases have been decided based on who signs an arbitration agreement, according to a McKnight’s Senior Living report in February. CMS ruled in 2019 that residents are not required to sign binding arbitration agreements as a condition of admission or to receive care, and this regulation was upheld in October 2021 by the 8th U.S. Circuit Court of Appeals. Nursing homes are permitted to use these agreements if they are explained to and acknowledged by the resident or family member that the contents are understood.

Read case examples of the enforceability of an arbitration agreement based on the signing party.


Hospital Groups Urge HHS to Renew COVID-19 Public Health Emergency

Hospital groups are urging HHS to extend the public health emergency due to staffing shortages, supply chain issues, continued covid cases, as well as other treatments that were delayed due to the pandemic.

The Public Health Emergency (“PHE”) introduced a handful of waivers that made it easier for hospitals and health systems to care for patients during the pandemic. The flexibilities waived certain Medicare, Medicaid, CHIP, and HIPAA requirements, including staff licensure requirements for practicing in other states, conditions of participation, and limitations of liability for some providers.

The regulatory waivers also made it easier to promptly discharge patients or transfer them to another care setting. HHS extended telehealth access for Medicare beneficiaries during the pandemic, increasing access to care for patients and allowing providers more flexibility to deliver care.

However, these temporary waivers will expire once the PHE is over.

Excelas is a national provider of medical record organization, retrieval and analysis, helping skilled
nursing organizations reduce risk exposures associated with gaps in record keeping, which could
affect audit scores, reduce defense costs, and shorten the claims lifecycle.

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