Anesthesia Coding Alert

Start now to ensure a smooth segue back to ‘normal’ standards.

For more than three years, federal and state agencies have waived or relaxed regulatory requirements and expanded reimbursement for services due to the COVID-19 public health emergency (PHE), but the conclusion is in sight. Many states have already ended their emergency exceptions, and the federal PHE is coming to a close on May 11.

Has your practice begun preparations for a return to normal standards, or are you unsure about how to unwind pertinent PHE-era policies and practices? Keep reading for some pro tips on steps that you can take to ensure a seamless transition.

Step 1: Start ASAP

While some of the popular waivers have been made permanent, others are set to expire at the end of the PHE. “Providers who are still relying upon waivers need to start acting now,” urges attorney Robert Markette Jr. with Hall Render in Indianapolis. The most important task, “especially now that we have a deadline, is to get moving,” Markette stresses.

“Once the PHE ends, unless otherwise noted, the waivers end,” Markette explains. “Providers need to be back to pre-PHE operations by May 11. If you are surveyed on May 12 and not back to ‘the old ways,’ you will almost certainly be cited,” he warns. “[Providers] should be using this time wisely. This will allow a planned, controlled rollout of new policies,” which are actually “the old pre-PHE policies,” he continues.

Bottom line: Begin reestablishing previous health and safety standards and billing practices. “We all remember the chaos around the waivers in 2020,” Markette recalls. “We can avoid that now because we have ample warning,” he says.

Step 2: ID Affected Policies

The first order of business is to identify those policies that your practice changed due to PHE waivers, so you can assess whether you will need to change them back — or transition to a new policy.

“As the PHE ends … flexibilities will go away and we will have to return to operating under” the original Medicare requirements, Markette observes. Some providers have already transitioned back to their old policies, either because their state PHE ended and their licensure required it, or because they simply no longer needed the leeway and were eager to make their transition to a post-PHE environment smoother.

“Indiana is a prime example” of the former, Markette says. “We are a licensure state. At the beginning of the pandemic, the state moved to waive certain licensure requirements. When the state ended the PHE last year, all of the state license waivers went away. This meant providers had to return to following state licensure requirements without the waivers. At that point, the Centers for Medicare & Medicaid Services (CMS) waivers did not matter,” he relates. So, don’t forget to check your own state’s policies.

Yet some providers never changed their policies, to begin with, and now don’t have to switch back.

Step 3: Narrow Down Expiring Waivers

Once you’ve identified policies you revised for the PHE, check to see whether the changes are being scrapped or have been extended or made permanent either via legislation or Medicare rulemaking, which includes telehealth flexibilities.

Example: During the PHE, CMS temporarily modified the requirement that a supervising physician be immediately available to also include circumstances where a supervising physician had a virtual presence via real-time audio and video technology. However, this Medicare flexibility will end with the PHE.

Also, make sure to pay attention to the particulars when evaluating your telehealth policies and procedures. While major telehealth flexibilities will remain in place until Dec. 31, 2024, the waivers that expanded the types of healthcare professionals who can provide telehealth services and allowed coverage for audio-only telehealth have only been extended to end 151 days after the PHE concludes.

Step 4: Create a Transition Plan, Put It in Motion

When you have your final list of policies that need to revert to pre-PHE rules, it’s time to draw up a plan for doing so. While the practice administrator is ultimately responsible for securing changes, a plan should designate who oversees the individual policy changes and deadlines for those to take place. Providers can use pre-PHE policies to guide them when needed, Markette suggests.

The plan also needs to set clear deadlines. “Make sure everyone involved understands that the deadline is a concrete deadline set by law,” Markette stresses.

Step 5: Train Staff

Begin educating staff on the new policies, making sure to shoot for compliance before the PHE expires, Markette recommends.

Keep in mind: Your staff has had two years to get into the habit of waiver-allowed policies. It may take time to get them compliant with the old requirements, especially when they add burden.

Step 6: Audit To Verify You’re on Track

Audit to confirm compliance with post-PHE procedures, then provide follow-up training based on the errors found, Markette advises. That training can be for all affected staff or for individuals, based on the pattern of errors detected.

Step 7: Boost Infection Control Protocol