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Compliance Matters: 2021 Therapy Compliance Risks

February 12, 2021
Compliance By Deborah Alexander, Director

In 2020, the Public Health Emergency (PHE) and COVID-19 impacted our lives in many ways which have changed us and our business operations going forward as we adapted to emerging risks. So, what are some of the possible risks?

Let’s start with the most recent risk to our practices - non-compliance with the Centers for Disease Control and Prevention (CDC), Occupational Health and Safety Administration (OSHA), and local and state health departments. Most of us have been consumed by and are still experiencing COVID-19 burnout. As a business owner or healthcare provider, it is important to comply with OSHA.




Non-compliance can result in the following:

  • Your practice could be identified, through contact tracing, as the source of an outbreak.
  • Your practice could have human resource related complaints filed for non-compliance with processing disability, FMLA, workers compensation for nosocomial COVID-19 infections or death claims, and unemployment compensation.
  • OSHA complaints filed against the practice or you, personally, by patients or employees who report not feeling the work environment has implemented safe practices per the CDC, OSHA, and State/Local Health departments.
  • Your practice could come under a Federal audit, such as what occurred with Hurricance Sandy. The Centers for Medicare and Medicaid Services (CMS) conducted large audits of providers who appear to have no decrease in volume while many municipalities were without power for weeks. These audits revealed fraud in some instances where the businesses were not actually operating or continued to operate without patient or worker safety considerations.

    Keep in mind CMS can audit claims volume and may do so at any time. CMS may be preparing to audit providers who did not appear to have a change in patient volume during the PHE. Obviously, volume is dictated by COVID-19 outbreaks in your geography, but CMS would expect to see patient volume drops to match outbreaks.

    Why could this be a risk to providers? Prior to the PHE, some Medicare Administrator Contractors (MACS) were starting to request patient schedules as part of their standard audit documentation request list. This most likely was to ensure one-on-one care was provided when one-on-one CPT codes were billed. Hence, this is where the risk may exist to practices who may not have seen drops in volume during the PHE. No drops in volume may indicate patient and employee safety was not a priority. Keep in mind, this is speculation, but based upon the CMS Hurricane Sandy Audits that took place, this is not a far fetched of idea.

How can LW Consulting, Inc. help?

  • LW Consulting, Inc.’s (LWCI) therapy consultants conduct routine audits for clients, which include audits of documentation to support medical necessity, unique skilled needs, CPT coding vs. minutes provided with comparisons to paid claims.
  • LWCI conducts patient schedule audits for clients to assess operational changes to schedules in support of one-on-one care for timed based CPT billing codes and reducing Impossible Day Scenario practices.
  • LWCI has created an outpatient provider specific OSHA Environmental, Health, and Safety Compliance Manual, which allows providers to implement the required OSHA training, policies, and procedures for outpatient practice owners.


LW Consulting, Inc. can assist you with your compliance program and/or conduct a documentation and coding audit. For more information, contact Deborah Alexander at 717-213-3122 or email

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