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Category Archives: Practice Management

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Nursing Home Fraud Scam Results in Conviction for “King of Nursing Homes”

Posted in Billing & Reimbursement, Fraud and Abuse, Medicare, Practice Management

Called by some the “King of Nursing Homes” for his many low-income nursing home patients in northeast Illinois, Dr. Venkateswara Kuchipudi was recently convicted for referring patients to Sacred Heart Hospital in Chicago in exchange for kickbacks.  Kuchipudi became the fifth physician and tenth defendant to be convicted for a massive Medicare and Medicaid fraud… Continue Reading

Time is Money: Study Reveals that U.S. Physicians Spend $15 Billion Yearly on Providing Data to Insurance Companies

Posted in Practice Management

Alexandra Sobol writes: A recent Weill Cornell Medicine study is breathing new life into the expression, “time is money.” The study, which was published in the March issue of Health Affairs, reveals that physician practices in the United States in four specialties — orthopedics, cardiology, family care, and internal medicine — spend 15 hours a week,… Continue Reading

CMS Finally Makes Reasonable Changes to 60-Day Overpayment Rule

Posted in Billing & Reimbursement, Fraud and Abuse, Health Reform, Medicare, Physician Compensation, Practice Management, Reimbursement

The Affordable Care Act (ACA) requires Medicare providers to return overpayments within 60 days of the date they are identified in order to avoid liability under the False Claims Act.  Four years ago, CMS issued a proposed rule to implement this statutory requirement that would have placed a substantial burden on providers to identify and… Continue Reading

Physicians and Practice Staff Are Not Required to Obtain Child Abuse Clearances in Pennsylvania

Posted in Articles, Employment Law, Pennsylvania Legislation, Practice Management

Previously on the Fox Rothschild Physician Law Blog, we reported on the July 2015 amendments to the PA Child Protective Services Law.  See our August 31, 2015 post here:  What You Need to Know about PA’s Child Protective Services Law.  In particular, we noted that the PA Medical Society interpreted the amendments to the Law… Continue Reading

Feds Extend Reporting Deadline of Employer Health Insurance Information

Posted in Practice Management

The federal Affordable Care Act requires certain employers to provide employees with forms reporting offers of health coverage and coverage provided by the employer in 2015 by no later than February 1, 2016.  Employers then had to report that information to the IRS by February 29 (by paper) and March 31 (electronically).  According to a joint press… Continue Reading

Offering Discounts (or Waivers) of Coinsurance/Copayments to Patients as an Out-of-Network Provider

Posted in Billing & Reimbursement, Fraud and Abuse, Medicare, Practice Management, Reimbursement

Commercial payors are actively looking for ways to reduce payments to out-of-network providers.  One area of focus is discounts and waivers of patient copayments and deductibles by out-of-network providers.  In the eyes of these payors, coinsurance/copayments are essential to incentivizing patients to use in-network providers, and discounts on (or waivers of) coinsurance/copayments by out-of-network providers… Continue Reading

An Effective Compliance Program is as Important as Ever

Posted in Practice Management

After many years counseling physicians regarding Medicare fraud and abuse compliance, I’m still perplexed at the general lack of understanding in the physician community regarding the need to comply with complex healthcare fraud and abuse laws and the serious risks of noncompliance.  Unfortunately, it seems that many physicians still mistakenly believe that they are “below… Continue Reading

New Study Suggests Defensive Medicine May Be Effective in Reducing Malpractice Liability

Posted in Billing & Reimbursement, Health Reform, Malpractice Insurance, Practice Management, Reimbursement

A new study in the BMJ suggests that the more services a physician provides to his or her patients, the less likely the physician is to be sued for malpractice.  The study examined the use of resources by attending physicians in several Florida acute care hospitals during a ten-year period from 2000-2009, in relation to… Continue Reading

The Switch to ICD-10

Posted in Billing & Reimbursement, Health Reform, Medicare, Practice Management, Reimbursement

The long-anticipated implementation of ICD-10 coding finally began this past Thursday, October 1, 2015.  As of that date, government and commercial payors ceased to accept claims under the old coding system (ICD-9).  The transition has been five years in the making due to a government delay in 2012. The new system has five times the… Continue Reading

Physicians May Be Sued in Pennsylvania for Failing to Report Suspected Child Abuse

Posted in Malpractice Insurance, Pennsylvania Legislation, Practice Management

As a follow up to our most recent post on What You Need to Know About PA’s Child Protective Services Law, you should know that the Pennsylvania Superior Court (PA’s primary appellate court) recently held that a physician may be sued for malpractice for failing to report suspected child abuse, even though there is not… Continue Reading

What You Need to Know About PA’s Child Protective Services Law

Posted in Employment Law, Pennsylvania Legislation, Practice Management

As of December 1, 2015, the PA Medical Society has retracted its opinion that physicians, health care practitioners and practice staff must obtain child abuse clearances under the PA Child Protective Services Law.  The PA Department of Human Services has also informally agreed that such practitioners and staff are not required to obtain clearances.  Please see… Continue Reading

First Court Decision on the Medicare/Medicaid 60-day Overpayment Rule

Posted in Billing & Reimbursement, Fraud and Abuse, Medicare, Practice Management, Reimbursement

You may have heard some years ago that the Affordable Care Act established a “60-day overpayment rule” that requires a provider to report and return any overpayment from a federal health care program (such as Medicare or Medicaid) within 60 days of “the date on which the overpayment was identified” by the provider (for certain… Continue Reading

Expanded Authority for CMS to Deny Enrollment and Revoke Medicare Billing Privileges

Posted in Articles, Billing & Reimbursement, Medicare, Practice Management, Reimbursement

You may have heard that CMS recently expanded its authority to deny enrollment and revoke the Medicare billing privileges of providers and suppliers.  The new changes could affect any physician, group practice or other Medicare provider or supplier.  As the changes are wide reaching, all Medicare providers and suppliers, and anyone providing support services for… Continue Reading

What is Your Strategic Plan?

Posted in Practice Management

This is the second in a series of posts on practical and legal considerations for physicians in deciding whether to sell, merge or stay the same. Before making any major practice decision along those lines, physicians should engage in some careful strategic planning. Simply put, before you can know which or whether one of these… Continue Reading

Employers in Philadelphia Must Provide Paid Sick Leave

Posted in Employment Law, Practice Management

Beginning May 13, 2015, employers must provide paid sick leave to employees who work in Philadelphia, per the City of Brotherly Love’s newly enacted Promoting Healthy Families and Workplaces Ordinance. The ordinance will undoubtedly elicit feelings of frustration rather than love because it requires employers to provide employees who work in Philadelphia with one hour… Continue Reading

Study Finds That Many Hospitals Are Losing Money On Physician Networks

Posted in Health Reform, Practice Management

In news that may not come as a shock to those of us who have been through the cycle of hospitals purchasing physician practices before, a recent study has found that hospitals are losing considerable amounts of money on acquired physician practices.  According to the study, 92% of reporting hospital CEOs state that they are… Continue Reading

Tips for Evaluating Provider Network Arrangements

Posted in Billing & Reimbursement, Practice Management, Reimbursement

In response to the development of alternative payment systems, provider networks are forming at a frenetic pace. If you are like most of my physician clients, you have been or will shortly be presented with network participation agreements for review (or in many cases, signature with very little opportunity to review) and consideration. In evaluating… Continue Reading

Does Your Practice Need a Disruptive Physician Policy?

Posted in Practice Management

One of the most challenging  problems I encounter in representing physician practice is disruptive physician behavior.  This type of behavior usually manifests in a host of unpleasant ways such as outbursts in the office or hospital, inapropriate language with office staff or patients or, perhaps most insidious, passive aggressive undermining of other physicians in the practice.  It can occur… Continue Reading

Physician Employment Agreements: For Cause or Not-For-Cause

Posted in Practice Management

As a health care attorney, I am called upon quite frequently to draft and/or review .  One of the recurring discussions I have with physicians about such arrangements revolves around the issue of contract termination.  Many physicians, understandably, are hopeful of securing an “iron-clad” employment agreement that cannot be terminated without some distinct finding of… Continue Reading

Healthcare Companies Score Low in Cybersecurity Study

Posted in Health Reform, Practice Management

An article on Businessweek.com today suggests that healthcare companies rank worse than financial institutions, utility companies and even retailers when it comes to cybersecurity.  This is particularly frightening news given the intense focus on healthcare data security under HIPAA for a number of years now.  By now, healthcare companies and providers should be well aware of… Continue Reading

Changes to New Jersey’s Mental Health Privilege

Posted in Practice Management

By Michael Coco The New Jersey Supreme Court, through the Committee on the Rules of Evidence (the “Committee”) is proposing changes to the rules on admitting evidence and allowing testimony from health care professionals involved in the counseling and treatment of mental health patients. As it currently stands, New Jersey has a patchwork statutes, evidentiary… Continue Reading