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KBML Issues Guidance to Help Physicians Get the Most out of MOST

November 10, 2015
Posted In Kentucky Board of Medical Licensure

The Kentucky Board of Medical Licensure (“KBML”) issued a recent opinion regarding the Medical Orders for Scope of Treatment (“MOST”) form. The stated purpose of the opinion is to “encourage and promote clarification of a patient’s treatment preferences into medical orders for care; and…encourage and promote transfer of information among healthcare professionals in a reliable and consistent format.” These goals coincide with the broader focus by both the healthcare industry and government at both federal and state levels in improving the continuum of care of patients through patient-centered care and information sharing. The MOST form, in particular, also evinces a focus on patient preference for end-of-life care. More >

OIG Alert Shows Increased Concern over Data Blocking

By Christopher J. Shaughnessy on October 27, 2015
Posted In Anti-Kickback Statute, EHR Systems, Electronic Health Records (“EHR"), Office of Inspector General of the United States Department of Health and Human Services (OIG)

In a report to Congress last April, the Office of the National Coordinator for Health Technology addressed the growing issue of data blocking. Data blocking occurs when some person or entity knowingly and unreasonably interferes with the exchange or use of electronic health information (“EHI”), and this happens due to business incentives that cause those persons or entities to want to control and limit availability to that information. For instance, if one ACO has the capability to send EHI of a patient safely and securely to another ACO treating that patient through a certified health IT system, but instead faxes that patient’s information, it has engaged in data blocking. It has made it more difficult, inefficient and expensive for the rival ACO to treat that patient. In essence, data blocking prevents the exact purpose of the HITECH Act and provisions of the Affordable Care Act which were designed to increase interoperability of electronic health information systems and facilitate the exchange of information. These broad concerns over data blocking found footing in a recent Office of Inspector General (“OIG”) Alert stressing that data blocking can run afoul of the Federal Anti-Kickback Statute. More >

OIG Targets Questionable Billing Practices for Ambulance Services

By Anne-Tyler Morgan on October 20, 2015
Posted In False Claims Act, Fraud, Health Care Fraud, Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG)

The Office of the Inspector General (“OIG”) pulled no punches in a recent report on Medicare Part B billing for ambulance transports. The September release presented a case for increased scrutiny, pointing out that Medicare has historically been vulnerable to fraud where ambulance transports are concerned. For instance, a 2006 OIG report determined that 25% of billed ambulance transports did not meet Medicare requirements in Calendar Year 2002. That year, Medicare paid almost $3 billion for ambulance services, and improper payments accounted for an estimated $402 million of that total. As 2012 saw Medicare pay $5.8 billion for ambulance services, the OIG took an even closer look at this category of claims. More >

The ICD-10 switchover: It’s here – are you prepared?

October 13, 2015
Posted In ICD-10

The day of reckoning is upon us – October 1st has now come and gone, and there was no other delay of ICD-10 implementation (the earliest proposed date of implementation was October 1, 2011, which was pushed back to October 1, 2013, then October 1, 2014, then the final deadline of October 1st of 2015 – there are only so many times one can press the “Snooze” button on ICD-10 implementation, apparently). The implementation of ICD-10 is in full swing, and healthcare entities that were unprepared will be feeling a significant impact if they have not begun the process. The importance of ICD-10 readiness cannot be understated, and healthcare entities that have yet to work on Phase 1 of implantation should understand that it isn’t too late to get ready for the change. More >

Primary Care Providers – Are you feeling the pinch?

By Lisa English Hinkle on October 6, 2015
Posted In Affordable Care Act, Medicaid, Patient Protection and Affordable Care Act (“ACA”), Primary Care Physicians ("PCPs")

It was nice while it lasted – due to a provision of the Patient Protection and Affordable Care Act (“ACA”), services furnished by certain primary care providers (“PCPs”) were subject to an enhanced payment rate for Calendar Years 2013 and 2014. These PCPs had to have (a) been Board certified in the specialty designation of family medicine, general internal medicine or pediatric medicine or have a subspecialty designation recognized by specific boards or associations, or (b) furnished more than 60% of claims in specific evaluation and management or vaccine administration services under certain codes to have been eligible for these enhanced payments.[1] The payments were raised to the level of the Medicare Part B fee schedule rate (unless the actual billed charge for the service was lower), and providers had until April 1, 2013 to self-attest to being eligible.[2] The increase applied to both fee-for-service and managed care Medicaid plans. More >

RHCs and FQHCs – It’s time to take a second look at Alternate Payment Methodology

September 29, 2015
Posted In Federally Qualified Health Centers (“FQHCs”), Kentucky’s Department for Medicaid Services, Medicaid, Rural Health Centers (“RHCs”)

In July of 2014, Kentucky Medicaid established an Alternate Payment Methodology (“APM”) for all Federally-Qualified Health Centers (“FQHCs”) and Rural Health Clinics (“RHCs”) as an alternative to the all-inclusive encounter rate per patient under the standard prospective payment system (“PPS”) of 42 U.S.C. 1369a(aa). The APM allows for qualified centers to be reimbursed at a rate of 125% of the 2014 Medicare Upper Payment Limit for RHCs in place of the PPS system ($99.75 per covered visit). There are more advantages to APM than meet the eye, however, and qualified centers currently using PPS method should at the very least reevaluate APM, as proposed changes will make APM even more attractive and potentially risk-free. More >

A Shot in the Arm of Preventive Health Services

By Anne-Tyler Morgan on September 22, 2015
Posted In Kentucky’s Department for Medicaid Services, Medicaid

The ripple effects of recent changes to the health care industry are still being measured, but Kentucky is already touting what it views as a positive impact of the Commonwealth’s decision to accept the Medicaid expansion under the law. More >

FCC Guidance on Cellphones Puts the Squeeze on Medical Debt Collectors

By Christopher J. Shaughnessy on September 15, 2015

In July, the FCC released an order it touted as strengthening “consumer protections against unwanted calls and texts.” It was a series of rulings based on the Telephone Consumer Protection Act meant to clarify the use of autodialers, procedures for wrong numbers and consent to call, mainly concerning cellphones. Under these new regulations, healthcare providers must get express written consent to be able to contact patients on their mobile phones about medical debt and billing. More >

NIST standards provides an oasis of mobile device security in the EHR desert

September 1, 2015
Posted In Data Breach, Electronic Health Records (“EHR"), Electronic Protected Health Information (ePHI), Health Information Technology for Economic and Clinical Health Act (HITECH Act), Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The healthcare industry has long awaited some certainty in the arena of mobile devices in light of the continued push for electronic health records (“EHR”) and coordinated care. The prevalence, convenience, and speed of such devices is beyond discussion. According to the 2015 HIMSS Mobile Technology Survey, found that 90% of healthcare providers use them in their organizations. Mobile devices provide clinicians with quick access to information at the point of care. However, the use of mobile devices brings a mountain of security risks for covered entities, including the loss or theft of the mobile device and unsecure exchange of health information. When every individual entering a facility has a mobile device, the large number of mobile devices using a facility’s network can overload the system. More >

An Analysis of Urine Toxicology — Considerations for Health Providers

August 18, 2015
Posted In Drug Screening, Health Insurance Portability and Accountability Act of 1996 (HIPAA), Urinalysis

Urine toxicology, also referred to as urine drug screening, is an important procedure that health providers use for several reasons: to monitor patients’ medication compliance, detect drug abuse, or identify the presence of disease. There are numerous implications that accompany a urine toxicology examination though, and health providers are sometimes left wondering if they should hand over the cup to patients. More >

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