Medicare Compliance & Reimbursement

Watch out: Deadlines for PRF reporting are fast approaching.

As the pandemic ebbs and flow, the feds continue to churn out COVID-19-related updates. And with new variants and spikes abroad causing concern, you should be ready for more policy changes in the months ahead. Read on for the latest news.

Context: You may be settling back into a routine as the COVID numbers decline, but beware of becoming complacent about the virus. Why? If we’ve learned anything from the COVID-19 public health emergency (PHE) and the impact on the healthcare industry, it’s to expect the unexpected. That’s why it’s critical for Medicare providers to stay on top of upticks in the virus and adjacent policy changes — both local (mask mandates) and federal (testing coverage).

Here are three updates across the Department of Health and Human Services (HHS) spectrum of agencies that may impact your compliance and reimbursement protocols:

1. Policy: CMS Returns to Some Pre-COVID Requirements for SNFs, LTC

If your organization has appreciated the plethora of waivers associated with the PHE, you’re not alone. However, the Centers for Medicare & Medicaid Services (CMS) wants to reinstate some of the pre-COVID-19 requirements in skilled nursing facilities (SNFs) and other long-term care (LTC) facilities, a CMS release indicates.

Now: With vaccination rates up and better outbreak protocols in place, “CMS is taking steps to phase out certain flexibilities that are generally no longer needed to re-establish certain minimum standards while continuing to protect the health and safety of those residing in skilled nursing facilities/nursing facilities (SNFs/NFs),” the agency says. CMS also plans to nix some waivers at inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities, too.

“Patient and resident health and safety are top priorities for CMS, and today’s actions are focused on ensuring every nursing home resident is cared for in a safe, high-quality environment,” says CMS Administrator Chiquita Brooks-LaSure in the release.

But: CMS is only getting rid of specific PHE waivers, and it will accommodate facilities that may experience surges. Certain flexibilities related to nurses’ aide certifications and COVID data tracking remain in place.

Review an April 7 memo to state survey agency directors, which includes a timeline on waiver removals and a list of impacted facilities, at www.cms.gov/files/document/qso-22-15-nh-nltc-lsc.pdf.

2. Tests: Medicare Benes Have More Free OTC COVID Test Options

If your Part B and Medicare Advantage beneficiaries are jamming your practice line asking for COVID-19 tests, the feds upped their over-the-counter test numbers, according to an April 4 release.

“We are expanding access to free over-the-counter COVID-19 testing for people with Medicare Part B, including those enrolled in a Medicare Advantage plan,” explains HHS Secretary Xavier Becerra in a release. “People with Medicare Part B will now have access to up to eight FDA-approved, authorized or cleared over-the-counter COVID-19 tests per month at no cost. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests free of charge.”

Nuts and bolts: “This new initiative enables payment from Medicare directly to participating eligible pharmacies and other health care providers to allow Medicare beneficiaries to receive tests at no cost, in addition to the two sets of four free at-home COVID-19 tests Americans can continue to order from covidtests.gov,” CMS notes.

Both institutional and non-institutional providers who already bill Medicare for these tests are eligible, CMS indicates. Find the provider fundamentals at www.cms.gov/COVIDOTCtestsProvider.

3. Attestation: HHS Will Allow Late PRF Reporting Until April 22

If you are behind on your Provider Relief Fund (PRF) paperwork for Reporting Period 1 (RP1), then you might be relieved by some recent news from the Health Resources and Services Administration (HRSA).

“Providers can now submit a Request to Report Late Due to Extenuating Circumstances Form for Reporting Period 1 (RP1),” online HRSA guidance says. “All requests for RP1 must be submitted by Friday, April 22, 2022 at 11:59 p.m. ET.”

Remember: Under the CARES Act, Congress allocated about $13.5 billion of financial aid to more than 86,000 healthcare providers struggling with pandemic fallout. HHS started disbursing the funds through General and Targeted distributions beginning in April 2020 — and are currently in the Phase 4 cycle of distributions. “The two major requirements for a provider to keep the PRF payment were to only use the funds for specific COVID-related purposes and to file a report with HRSA justifying use of the funds,” reminds law firm Wachler & Associates, P.C., in a blog post.

The original deadline for RP1 was Sept. 30, 2021, but the due date was extended for an additional 60 days (see Medicare Compliance & Reimbursement, Vol. 47, Nos. 13 and18).

“In March 2022, HRSA began sending letters to providers who had not filed reports indicating that they were now required to return the full amount of any PRF funds received within 30 days. After significant outcry from providers, representatives, and industry groups, HRSA has backtracked and will now accept requests to file late reports,” Wachler says.

This led to the updated policy, but providers must meet certain requirements.

“In order to meet the ‘extenuating circumstance’ threshold, a provider must attest that one of the following allowable extenuating circumstances applied at the time of the deadline,” note attorneys Alexander B. Foster and Hedy Silver Rubinger with law firm Arnall Golden Gregory in online analysis. Those extenuating circumstances to be eligible to apply, according to HRSA guidance, include: severe illness or death; impacted by natural disaster; lack of receipt of reporting communications; failure to click “Submit;” internal miscommunication or error; or incomplete Targeted distribution payments.

Know this: “Providers who submit a request will be notified by HRSA if their request is approved or denied,” HRSA explains. “Providers whose request is approved will receive a notification to proceed with completing the report. Providers whose request is denied will need to return their funds to become compliant with their PRF reporting requirement,” the agency cautions.

Bonus: Reporting Period 2 (RP2) has closed. At this time, a late request deadline has not been determined; however, a date is expected to be announced, the HRSA website suggests.

If you intend to request a reporting extension for extenuating circumstances, you must register through the PRF portal and meet HRSA’s criteria. Read other requirements and find the application at www.hrsa.gov/provider-relief/reporting-auditing/late-reporting-requests.