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McBrayer Blogs
Physicians Facing an Increased Risk of Qui Tam Suits
On April 9, the Centers for Medicare and Medicaid Services (“CMS”) released data showing physicians’ compensation for Medicare Part B billing payments in 2012. It was the first time in more than 35 years the data has been made available to the public and it unleashed a fire storm of national headlines. Most news outlets, unfortunately, failed to explain the facts behind the figures. More >
Tips for New Enrollment & Revalidation for Participation in Medicare & Medicaid
The new enrollment and revalidation requirements for providers and suppliers for Medicare/Medicaid participation was previously detailed on this blog. As promised as a follow-up, this blog post will describe enrollment best practices and tips for ensuring that enrollment or revalidation is properly accomplished. Not only is initial enrollment now more onerous, but revalidation is required for all physicians and other providers/suppliers who were enrolled before March 25, 2011, which generally means that all physicians and physician groups must complete the re-enrollment process. A failure to re-enroll means that CMS will de-activate payment until a successful re-enrollment process is completed. In some cases, CMS may even revoke participation. Thus, it is crucial that physicians, providers, and suppliers get it right the first time. More >
Physician Reminder: On-Site Supervision of PA’s No Longer Required
Physician assistants are increasingly playing an active role in patient care and states are finally modernizing practice laws, making it easier for them to do so. In March of 2013, Governor Steve Beshear approved a law, finalized in House Bill 104, which removed the stringent state requirement that physicians be on-site with PAs during their first 18 months of medical practice. The law approved a reduced physician supervision time of three months for newly-graduated PAs through May 2014. In addition, under the law, the supervision requirement is eliminated altogether as of June 1, 2014. The bill garnered national attention and even made headlines in the Wall Street Journal (see Melinda Beck, Battles Erupt Over Filling Doctors’ Shoes, Wall Street Journal, Feb. 4, 2013), as Kentucky was the only state with such a lengthy on-site requirement and one of only three states in the country with any such period of time for new PAs. More >
FINALLY SOME RELIEF TO PROVIDERS—CMS ORDERED TO NO LONGER APPLY A COMMON RULE OF THUMB WHEN AUDITING
Health care providers are always at risk of a payor audit, and contracted auditors seem to be more aggressive now than ever. While MIC, MAC, and ZPIC audits as well as pre-payment reviews of late have become more efficient with the use of rules of thumb to flag specific codes commonly misapplied, the U.S. District Court of Vermont’s ruling in Jimmo v. Sebelius puts the brakes on such fishing expeditions. In holding that, in the case of skilled nursing services, there is no “improvement standard” and claims should be reviewed on a case by case basis, the court has limited CMS in its ability to apply arbitrary standards in denying reimbursement for covered services. More >
Electronic Data Breach Leads to Largest HIPAA Settlement to Date
Recently, the Office of Civil Rights (“OCR”) of the Department of Health and Human Services entered into a $4.8 million dollar settlement with two New York-based health care organizations after a data breach involving electronic protected health information occurred. The agreement is the largest HIPAA settlement thus far. More >
Time to “Face” The Risks
In 2011, the U.S. Centers for Medicare and Medicaid Services (“CMS”), as part of the reform instituted by the Affordable Care Act, required that home health agencies and hospice patients receive a face-to-face visit (at specified time periods) by a physician or nurse practitioner to ensure that they continue to meet Medicare and Medicaid eligibility criteria. More >
All Eyes on Hospice Care
In 2013, the Department of Justice (“DOJ”) and Office of Inspector General (“OIG”) charged the nation’s largest for-profit hospice chain, Vitas Innovative Hospice Care (“Vitas”), with false Medicare billings, inappropriately admitting patients with “aggressive marketing tactics,” and misleading patients and families about Medicare hospice benefits. This suit is just one of many recently filed against hospice providers, indicating that they are being watched keenly by enforcement authorities and government agencies. More >
Important Reminder for Association Group Health Plans
In Kentucky, most trade association-sponsored health plans renew on July 1, 2014. Now is an excellent time for trade association executives to review association and Health Plan materials to ensure compliance with applicable Federal and State requirements prior to renewal. More >
Voluntary Surrender of DEA Registration: Proceed With Caution
All too often, the Drug Enforcement Agency (“DEA”) asks a physician to surrender his or her DEA registration when the physician enters into a prescribing-related Agreed Order with the applicable state licensing authority. A DEA registration is important because, in order to write prescriptions for controlled substances or dispense controlled substances in-office, physicians must be registered with the DEA. More >
Physicians: Have You Checked Your Numbers?
As promised, the Centers for Medicare and Medicaid Services released information about Medicare payment to physicians and certain health care professionals on April 9th. The release is in conjunction with the policy change instituted by the U.S. Department of Health and Human Services, which allows CMS to respond on a case-by-case basis to Freedom of Information Act requests for Medicare payment information related to individual physicians (see more on the topic here). More >
