Practice Management

Practice Compliance in the COVID-19 Era: Key Actions for You to Take

By Peter J. Cass, OD

May 27, 2020

The COVID-19 crisis has changed many aspects of practice. Some of those changes have been for the better, but many have made things more frustrating. One area that is becoming a bigger concern is compliance, as many of the changes associated with the COVID-19 crisis have cast an unwelcome light on this area.

None of us can afford an audit, fines or lawsuit as we are trying to restart our practices and return to normal. Here are key areas to review to ensure practice compliance as you reopen.

Hazards (OSHA/Centers for Disease Control/Clinical Laboratory Improvement Amendments ) Compliance
This was an often-ignored aspect of practice prior to the COVID-19 crisis, but we now face new regulations from OSHA, the CDC, and state and local authorities, as well as increased scrutiny from our patients, our staff and the public. OSHA has been flooded with thousands of complaints filed against companies for coronavirus workplace safety concerns.

What you need to do: Make sure you have complete Hazard Policy Manual including at least the following policies:

  • Exposure control / response policy
  • Universal precaution policies
  • Sterilization/disinfection policies
  • Standards for hazardous chemicals
  • Workforce safety protocols
  • Emergency action plans

Make sure the manual is accessible to your staff and that you have provided them with adequate training. You do not necessarily need pandemic policies in your manual, but you could certainly create a standalone supplement if you wanted (that level of detail is not required in general policies/manual).

Human Resources Compliance
Crisis brings out the best…and worst in people. If your employees think you are not treating them fairly, or making them work in unsafe environments, they may be more likely to file a complaint or hire an attorney.

Most of us have had to make many tough decisions about layoffs, furloughs, rehiring, sick leave and other issues during this time. Those decisions must be driven by sound, documented policy and applied equally to all employees. If you delegate HR responsibilities, that person MUST know what they are doing and how to deal with and avoid situations like:

• Flexible and consistent sick leave policies
• Payroll adjustments focused on Paycheck Protection Program forgiveness
• Leniency on demanding evidence of illness or return to work verification
• Managing concerns over pay, leave and job stability
• Managing concerns over health of employee and employee family
• Discrimination

What you need to do:
Make sure you:

  • Have a complete, state law specific employee manual – and
  • Keep up with the frequent changes (HR is the fastest changing compliance area in small business law)
  • Train management

HIPAA
While some restrictions have been relaxed on telemedicine delivery, new ways of communicating with patients are already causing doctors to make accidental breaches (Practice Compliance Solutions has already had to deal two massive breaches due to improper communication).

Make sure that you have:

  • Privacy manual (and have designated a privacy officer)
  • Security Manual (and have done a security risk assessment and designated a security officer)
  • Notice of Privacy Practice
  • Acknowledgement of Notice of Privacy Practice
  • Documentation of staff training
  • Documentation of yearly review
  • Business Associate Agreements

These documents must all be up to date and include the 2010, 2011, 2012, 2013, 2014, 2016, 2017 AND 2018 updates and additions.

Fraud & Abuse
Ascension reports a 2,000 percent increase in the use of telemedicine in the last two months. Telemedicine will now be a regular part of care, but you have to know the new rules on telemedicine, and proper billing must be followed. Now is a good time to review your other documentation billing protocols as well.

What you need to do:
Make sure that you have:

  • Policy manual
  • Documented staff training (doctors and staff)
  • Conducted an internal records review

It might feel like the government is kicking us when we are down, but it just spent trillions that it did not have. Government officials will be looking for ways to recoup some of that through audits, investigations, penalties and fines. Unfortunately, the government has a history of doing so in programs like Meaningful Use, PQRS, the Employee Incentive Program and IRS audits.

In fact, the first arrests over Small Business Administration loan fraud have already occurred. Make sure that you take the time now, while you can, to review and set up compliance protocols in your office.

Peter J. Cass, OD, practices in Beaumont, Texas, is Past-President of the Texas Optometric Association, a member of the TOA COVID Task Force, the Texas Optometry Board COVID Task Force and a partner in Practice Compliance Solutions. To contact: peter@practicecompliancesolutions.com

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