(4 min read) CQI involves more than just checking reports to make sure that the “red” went away, it’s a continuous process focusing on ...
Christopher Kelly | January 9, 2020
(4 min read) As we head into 2020, it is a good time to get a check-up. I’m not talking about a trip to your doctor, I’m suggesting a check-up of your company. Whether you are in the management of an ambulance service or a company that works with them, some things need a good annual review. As a leader of your organization, it is up to you to make sure that you are healthy in these areas. Here are our top five:
Whether you have been selected in year one or not, it is important to understanding the new CMS Ambulance Cost Data Collection process and what is expected of you before you have to start reporting. Get familiar with the definitions and the reporting tool now so that you will know how to collect and quantify the required information during the year. If you are not up-to-date on this when it comes time to report, you will be way behind the curve, so don’t procrastinate! Watch for our webinar series on this as well.
The 855(b) form contains all of the information that Medicare thinks is important to know about you and your company. Have you moved, have you opened or closed an alternative address (like a P.O. Box), have you opened an additional location (maybe in a new zip code), or have key employees been replaced? If so, chances are your enrollment form is out of date and needs to be revised. If you catch it before Medicare does, you should be OK. If Medicare catches an error before you correct it, it could lead to the immediate and irreversible termination of your provider number. The new Cost Data Collection requirement may also cross-reference some of your enrollment information, so it must be correct and up-to-date.
Just last month, we saw the first-ever HIPAA penalty issued to an ambulance service by the OCR. While it was not the largest fine in HIPAA history, it was significant and shows that we are now on the OCR radar. For this reason, HIPAA compliance should be on the top of your list of things to check-up on this year. The on-site and “desk” audits for HIPAA compliance by the OCR are on the rise, and the fines can be huge. So check your policies and make sure your actual practices match up with them. Update your security and operating software, conduct your 2020 “risk analysis,” and document the results. If you do not have any of those in place, don’t be afraid to ask for help.
Failure to ensure that all individual certifications and licenses are up-to- date can cause a loss of revenue. Inadvertently allowing an EMS practitioner to function without proper certifications and licenses can result in paying money back to Medicare, as well as civil monetary penalties and state license suspensions. You must get these items on your radar, and carefully monitor all staff credentials and your agency licenses. Also, begin the process of renewal at least a few weeks before you think you need to, just in case you have to resubmit or revise your application and need the extra time.
If you already have a compliance program in place, now is a good time to make sure it is functioning effectively. Keep in mind that compliance must be more than a policy or document. It needs to be a living and breathing program in which everyone knows who to turn to with a compliance concern. Last year, we saw a court dismiss a False Claims Act case where two of the reasons they did were that the company had NAAC certified employees and an active compliance program. The only thing worse than not having a policy is having one that you do not follow. So if your program is not up-to-date, if your compliance officer has retired, if your people don’t know the name of your compliance officer, or if you have items that are not actively being addressed - now is the time to fix these deficiencies and implement a Compliance program that works for and protects your company.
This list is certainly not exhaustive, but those are the top items that we think your administrative office should check on. And now is a good time to do it!
G. Christopher Kelly is an attorney with the law firm of Page, Wolfberg & Wirth, where he focuses on the ambulance industry. He writes regularly for EMS World and sits on the magazine’s editorial advisory board. He has co-authored two guides on HIPAA for EMS and ambulance services. He has been an adjunct instructor for Virginia College, teaching Legal Aspects of Healthcare Administration and Health Law and Ethics. Chris represents many ambulance services in Medicare audits and formal investigations, State licensing issues, contracting issues, over-payment appeals and other EMS related matters, winning several cases that have had major impact on ambulance reimbursement in the U.S.