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New Update to the Medicare Program Integrity Manual Issued by CMS

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On June 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued further guidance for reporting and reviewing final adverse legal actions (ALAs) in provider enrollment applications. Section 15.5.3 of the Medicare Program Integrity Manual (MPIM) was updated through Transmittal 797 to provide more guidance on the types of final adverse actions that must be disclosed. It also provides additional instruction to Medicare Administrative Contractors (MACs) on how to process disclosed final adverse actions.

New Language Basics.

The update in Section 15.5.3 of the MPIM clarifies the scope of disclosure, the time frames for disclosure and the evidence needed to support a disclosure.

Per the 2018 update, the list of reportable adverse actions includes: felony and misdemeanor convictions within the last 10 years; current or past suspensions/revocations of a medical license or an accreditation; current or past suspensions or exclusions imposed by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG); current or past debarments for participation in any Federal Executive Branch procurement or non-procurement program; Medicaid exclusions, revocations, or terminations; and current or past federal sanctions of any type.

New Guidance for MACs.

The second part of the update to the Manual provides additional guidance concerning how MACs will review applications and process the disclosure of final adverse actions. The update also covers how MACs should handle both reported and unreported adverse actions. MACs are now required to use either the Provider Enrollment, Chain and Ownership System (PECOS) or the System for Award Management (SAM) to research whether individuals with ownership interest of the applicant entity are excluded.

To view all the language in Transmittal 797, which outlines the updated Section 15.5.3, click here.

For more information, visit CMS’ website.

Click here to view another recent update issued by CMS.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, skilled nursing facilities (SNF’s) durable medical equipment (DME) suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative
hearings at both the state and the federal level. We represent health providers in Medicare and Medicaid audits and disputes on a routine basis.

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.ThehealthLawFirm.com.

Sources:

King & Spalding. “CMS Updates Rules for Reporting Adverse Legal Action.” JD Supra. (August 25, 2018). Web.

Dhillion, Megan. “Update to the Medicare Program Integrity Manual: New Requirements Related to Disclosing and Processing Final Adverse Actions.” AHLA. (August 24, 2018). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
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CMS Memorandum for Texting Patient Information Among Healthcare Providers

George F. Indest III headshot

June 21, 2018

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Centers for Medicare & Medicaid Services (CMS) released a Memorandum in an effort to clarify their stance and guidelines on texting between healthcare providers and staff.

Texting Patient Orders is Not Permitted.

CMS does not permit  health care providers to text patient orders to a care team member on any platform. Therefore, texting patient orders from a health care provider is not in compliance with the Conditions of Participation (CoPs) or Conditions for Coverage (CfCs).

Texting Patient Information on Secure Platforms.

Patient information that is sent via text messages  is permissible if accomplished through a secure platform only. However, Computerized Provider Order Entry (CPOE) is the preferred method of order entry. CMS holds to the long-standing practice that a physician should enter patient orders into the medical record via a hand written order or CPOE.

Compliance Plans.

Furthermore, in order to be compliant, all healthcare providers must utilize and maintain platforms that are secure, encrypted, and minimize the risks to patient privacy. It is expected that providers/organizations will implement procedures that routinely assess the security and integrity of the texting platforms that are being utilized. This is to ensure patient confidentiality and to avoid negative outcomes that could compromise the overall care of patients.

Using secure texting platforms, has the potential for healthcare organizations to streamline contact and improve patient outcomes. Click here to visit our website and read the CMS Memorandum in full.

Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other health care providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001. Be sure to check The Health Law Firm Blog for regular updates.

Source: Center for Clinical Standards and Quality/Survey & Certification Group . “Texting of Patient Information among Healthcare Providers.” Centers for Medicare and Medicaid Services (CMS). (December 28, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.