What Healthcare Compliance Needs to Know After COVID-19


Post By: Nathan J. Ward, JD Manager, Compliance & Content Development, youCompli

When the COVID-19 pandemic hit, compliance officers and other compliance professionals were left scrambling to adjust. State and federal regulators rapidly issued a high volume of regulatory changes, suspensions, waivers and other notices in an effort to stay ahead of any potential surge in pandemic-related cases through the hospital systems. Dealing with this surge kept all of us busy.

Now, however, quarantines and lockdowns are being eased. While we are all social distancing and wearing masks, we are starting to get back to some of our usual activities.

Regulators are beginning to move in a similar direction and are getting back to something resembling business as usual. What does that mean for compliance professionals?

The Current State

In our day to day work, my team and I track regulatory changes at the federal level, and across several states. We need to know what the regulators are doing, and try to anticipate what to expect next.

The Medicare Administrative Contractors (MACs), perhaps surprisingly, really didn’t deviate much from business as usual. Except for a period of a few weeks in April, the MACs have continued to issue their usual updates of billing and coding guidelines. Compliance officers who haven’t been paying attention should be aware, especially as non-COVID treatment and procedures begin to return to their normal volumes for providers.

There are three broad regulatory trends that healthcare compliance professionals should be aware of. Failing to do so could lead to serious compliance issues and the potential for regulatory fines or other costs.

(1) Virtual Health

Telehealth and other forms of virtual health appointments and treatment surged during the pandemic, as patients – particularly older Medicare patients – were understandably unwilling to visit clinics and hospitals to obtain necessary treatment. CMS adjusted their regulations accordingly, to ensure that providers could use these technologies to continue to care for their patients.

According to CMS Administrator Seema Verma, these changes will become permanent. And not only are regulators willing to continue to reimburse for these forms of treatment, they have been very well-received by the public.

This innovation was probably going to come anyway. In their daily lives, patients are becoming more comfortable with video chats and other forms of online communication. The pandemic has really accelerated a process of regulatory change that was already visible in the distance.

If you’ve already been providing telehealth services, now is an ideal time to review the regulatory requirements, and make sure your organization is in full compliance. If you haven’t made the leap into virtual health, you should be preparing your organization for what is to come. Regulations are strict, and CMS will not reimburse for virtual treatments that are non-compliant.

(2) Clearing the Backlog

COVID-19 disrupted many industries, and government was no exception. Many legislative and regulatory changes that had already been planned were suspended or put back on the shelf.

As we come out of the pandemic, these changes will start being pushed through, likely all at once. In Maryland, for example, the Governor recently announced actions on a mountain of legislation passed in the 2020 Legislative Session. Obviously, this does not all apply to the healthcare sector, but it would be easy for a law that does apply to get lost in that mix.

The principal concern should be about managing the volume of changes. Every change must be implemented according to the revised deadlines and there will likely be no exceptions given for the fact that the volume has dramatically (but temporarily) increased.

There is a significant risk here for compliance professionals. If your existing compliance management system can’t scale up to meet the new volumes, your organization could be facing significant penalties. You will need to monitor all relevant regulatory bodies – both federal and state – very carefully, to ensure that no new regulations or regulatory changes fall through the cracks.

You should also expect that the departments within your organization will have to make process changes to live up to the new regulatory framework, and thus will need a strong communication and project management process in place.

(3) Expiring Waivers

To manage the pandemic effectively, regulators issued temporary waivers for several regulatory requirements, particularly those related to professional licensing and reporting periods. CMS and state regulators also issued waivers on reporting requirements, respecting the fact that hospitals and other healthcare providers were stretched to manage the surge of COVID patients, and thus didn’t have the resources necessary to deliver the necessary reports. These waivers are unlikely to be extended or renewed, as there is a strong push at all levels of government to get back to “normal.”

When these and other waivers expire, healthcare organizations will need to get into compliance with the “normal” regulations – fast. If you haven’t been tracking the changes you’ve made to policies and procedures, this could be a very challenging problem. A full audit will need to be conducted to identify all policy and procedure changes that have been made. If you have this information already, then you’re ahead, but still have work to do.

You will need to systematically compare your list of changes to the list of relevant federal and state regulatory waivers to see which will need to be reverted and which can be maintained. Once this is done, you will need a good communication process to cascade this information through your organization, and ensure that changes are made as necessary.

The Future

It’s hard to say where the COVID-19 pandemic goes from here. We are all hopeful that the worst is over, and we can continue to get back to normal. If this hope is ill-founded, then we may all go back into quarantine, with emergency regulatory changes coming back into place.

What we can say for sure is that the regulators are acting as if we are getting back to the way things were. Even while hospitals and healthcare providers are struggling with budgetary gaps, compliance will need to find a way to keep up to the standards the regulators have set and are going to enforce.