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McBrayer Blogs
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 >
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 >
