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McBrayer Blogs
Update: CMS Issues Revised Guidance on Hospice & Part D Prior Authorization Process
A few weeks ago, we discussed CMS’ newly-issued guidance establishing a prior authorization process for Hospice and Part D providers (read more here). As our previous blog post emphasized, soon after its March 10 implementation, advocacy groups, Hospice associations, and Members of Congress began urging CMS to suspend the process. According to opponents, the prior authorization requirement creates a barrier for beneficiaries to access necessary medications and leaves them to navigate complicated payor disputes in the midst of their terminal illnesses. More >
Labs & Referring Physicians Take Note of OIG’s Special Fraud Alert
Recently, the U.S. Department of Health & Human Services, Office of Inspector General (“OIG”) issued a Special Fraud Alert (“Alert”) entitled, “Laboratory Payments to Referring Physicians.” The Alert focuses on (1) Specimen Processing Arrangements and, (2) Registry Arrangements. These arrangements, according to the OIG, pose substantial risks for fraud and abuse under the federal Anti-Kickback Statute. More >
New Part D Regulations Face Increased Scrutiny from Advocacy Groups & Congress
On March 10, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, "Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 Guidance" (“Guidance”). The Guidance, effective since May 1, 2014, requires a prior authorization process for Hospice and Part D providers to determine their respective responsibility for drug coverage. The Guidance followed a 2012 OIG report entitled "Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice,” which found that Medicare Hospice patients’ medications were sometimes paid for by Part D rather than by the patient’s Hospice program. More >
New Law Affecting APRNs Takes Effect Today
Today, Senate Bill 7, signed by Governor Beshear on February 26, 2014, becomes effective. The new law allows for an Advanced Practice Registered Nurse (“APRN”) to request to discontinue a Collaborative Agreement for Prescribing Authority for Non-Scheduled drugs (“CAPA-NS”) after having a CAPA-NS in place for four years. Specifically, the new law states: More >
Have You Reviewed Your Existing Business Associate Agreements?
Pursuant to the HIPAA Final Omnibus Rule (“Final Rule”), covered entities and their business associates were required to enter into new business associate agreements (“BAAs”) or modify existing BAAs by Sept. 23, 2013. However, existing BAAs that (i) were entered into on or before Jan. 25, 2013; (ii) met the requirements that were applicable prior to the promulgation of the Final Rule; and (iii) were not modified after March 26, 2013, have until Sept. 23, 2014 to be updated. That deadline is quickly approaching. More >
OCR Offers “Lessons Learned” Regarding HIPAA Compliance, Part II
On Tuesday, some of the details of OCR’s recently released Breach and Compliance Reports were discussed. In addition to detailing facts and figures from cases involving breaches in 2011 and 2012, the Breach Report includes an important “Lessons Learned” section that all covered entities and their business associates should review. Based upon reported breaches, the OCR has outlined some specific areas of concern, which include the following: More >
OCR Offers “Lessons Learned” Regarding HIPAA Compliance
Two recent reports issued by the HHS Office for Civil Rights (“OCR”), pursuant to the HITECH Act, reveal some interesting information about HIPAA data breaches. The Annual Report to Congress on Breaches of Unsecured Protection Information (“Breach Report”) and the Annual Report to Congress on HIPAA Privacy, Security, and Breach Notification Rule Compliance (“Compliance Report”) should remind covered entities and their business associates about the many risks associated with HIPAA and the importance of compliance. More >
More on the AMA’s Guiding Telemedicine Principles
On Tuesday, we began to discuss the AMA’s new guidelines for telemedicine. These guidelines indicate the growth and increased comfort level of telemedicine’s use in day-to-day practice. The AMA’s report does not approve or disapprove of any specific technology, but does make the following recommendations for the delivery of health care services via telemedicine: More >
AMA Releases Guiding Principles on Telemedicine
The American Medical Association (“AMA”) recently approved “guiding principles” regarding the provision of medical services through telecommunications technologies, i.e. telemedicine. These principles stem from a previous policy report developed by the AMA’s Council on Medical Service and address major issues in telemedicine, including: More >
Medicare Part D Prescribers Must Act Now
On May 19, the Centers for Medicare & Medicaid Services (“CMS”) issued final regulations which require doctors prescribing drugs for Part D patients to enroll in Medicare. In addition, the regulations establish authority for CMS to revoke a doctor's Medicare eligibility for abusive prescribing practices, among other provisions. The regulations are part of the ongoing effort to curb fraud and abuse and to improve benefits and the quality of care for seniors and people with disabilities enrolled in these programs. More >
