According to a final rule published by the Centers for Medicare and Medicaid Services on August 4, 2014, providers will be required to use the International Classification of Diseases, 10th Revision for diagnosis coding starting on October 1, 2015. Until then providers are to continue using the 9th Revision (ICD-9). Given the winding path that ICD-10 has… Continue Reading
Physician ancillary service joint ventures continue to proliferate and not surprisingly, federal and state regulators are on the lookout for arrangements which may violate fraud and abuse laws . In its recent “Special Fraud Alert: Laboratory Payments to Referring Physicians”, the Office of Inspector General (OIG) has (once again) expressed concern over financial arrangement between… Continue Reading
The topic of telemedicine is becoming increasingly more common in the medical community. For certain, telemedicine can be a cost effective way of communicating with and monitoring patients, but it is not without its risks. For one thing, physicians need to be mindful of the potential for increased malpractice exposure which could come from not… Continue Reading
Many physicians I speak with are still surprised to learn that the federal Stark statute imposes restrictions on income division within group practices. These restrictions only apply to profits generated from any of the Stark “designated health services” and only those that are covered by Medicare and Medicaid (including managed care), but if your group provides… Continue Reading
Hospital-physician acquisition of medical practices continues at a furious pace. Unfortunately, no one knows for certain whether physician employment by hospitals is the key to better or more cost-effective care. Moreover, the hospital or the physician in such a transaction may for any number of reasons decide later on that the relationship is less than desirable. Because… Continue Reading
Hiring a new physician into a practice can be an expensive and risky proposition but for most practices it is a necessary endeavor. Aside from the actual costs of recruiting and negotiating a contract with the new physician, there are associated increases in overhead, and perhaps most importantly, the risk of damaging valuable practice goodwill in the… Continue Reading
As the implementation of the federal Affordable Care Act (ACA) continues in fits and starts, healthcare providers are scrambling to best position themselves to accommodate anticipated and developing payment models. Unfortunately no one really knows what these new payment models will look like or how they will ultimately work. It is apparent, however, that most… Continue Reading
The article Pediatricians v Retail Clinics: Is It Time to Think Beyond the Office Visit? published today at time.com, highlights an important shift occurring in the delivery of physician services. Patients are foregoing their regular physician office visits in favor of “as-needed” treatment from retail clinics, urgent care centers and walk-in clinics springing up around… Continue Reading
Earlier this year, the Department of Health and Human Services (HHS) published the “HIPAA Omnibus Rule,” implementing various provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act as the related to the HIPAA Privacy, Security, and Enforcement Rules. If you are a “covered entity” or “bsuiness associate” under HIPAA, these new… Continue Reading
Earlier this month the closely watched case of U.S. ex rel Drakeford v Tuomey Healthcare System Inc. (675 F.3d 394 (4th Cir. 2012) concluded with a jury finding that the compensation paid to physicians under certain part-time employment agreements by Tuomey Healthcare System resulted in violations of both the federal False Claims Act and the… Continue Reading
In what would undoubtedly be a devastating blow to many medical practices that rely on the Stark in-office ancillary services exception (which allows physicians to refer within their practices for Stark services), President Obama’s proposed FY 2014 would seek to eliminate the exception for physical therapy, radiation therapy and advanced imaging such as CT and… Continue Reading
Adding an interesting wrinkle to an already complex environment, the Federal Trade Commission filed a suit this month to block an Idaho hospital from acquiring a physician practice. According to an article on thomsonreuters.com, the FTC and the IDAHO Attorney General have filed an antitrust complaint seeking to block St. Luke’s Health System’s acquisition of… Continue Reading
Yesterday the U.S. Department of Justice announced that it has entered into a $26M False Claims settlement with a dermatologist in Florida. According to the DOJ, this is one of the largest False Claims settlements against an individual in history. The physician was accused of allegedly accepting kickbacks from a pathology lab and billing for medically… Continue Reading
I imagine that few physicians contemplated being part of organized labor when they enrolled in medical school but as more and more physicians make the leap from private practice to hospital employment, perhaps large-scale unionization of the physician workforce could become a reality. According to an article by David J. Leffell today on WSJ.com, the notion… Continue Reading
Last week the U.S. Department of Health and Human Services (HHS) released final regulations modifying existing HIPAA enforcement, privacy and security regulations.
With the emphasis placed on primary care under the federal Affordable Care Act, what will the federal government need to do to entice the best and the brightest to go into primary care?
If you’re like most physicians, you have probably given some recent thought to selling your practice or merging with one or more other groups. If you are part of a group practice, it’s quite possible that all members of the group might not agree on a single course of action. Keep in mind that even… Continue Reading
This week the Office of Inspector General of the Department of Health and Human Services published Advisory Opinion 12-15 in which it blessed an on-call compensation arrangement between a hospital and specialist physicians on its staff.
On October 9, the Pennsylvania Department of Health (PA DOH) announced that it has changed the Pennsylvania rules regarding the J-1 Physician Waiver Program. DOH has established three filing periods, which could result in the Conrad 30 numbers being assigned earlier in the fiscal year. Read the entire text: http://immigrationview.foxrothschild.com/j-1-waiver/j-1-physician-waivers-in-pennsylvania-change-in-processing-times/
Physician shortage may have a silver lining for physicians who choose to stay in practice: short supply means higher demand and higher demand is likely to mean increased reimbursement.
Recent press releases provide notice of activities that draw the government’s ire — and result in serious criminal consequences. Focusing on these issues is a helpful exercise for any physician trying to stay within the law.
Do you have a succession plan for your medical practice? In my experience, too many physicians wait until close to retirement age to begin developing a plan to transition out of practice. Given the volatility of the healthcare market, you should certainly not assume that there will be a ready and willing buyer for your… Continue Reading
Health care fraud and abuse enforcement activity is at an all-time high yet many physicians and other providers lack a basic understanding of the key healthcare fraud and abuse statutes that apply to them. Although each state may have its own fraud and abuse laws, any healthcare provider that receives federal funds should be familiar… Continue Reading
I have been speaking with physicians for years about the importance of developing effective fraud and abuse compliance programs in their practices and I often still get the same response: The government is only interested in the big fish like pharmaceutical manufacturers and hospitals -physicians are under the radar. Well, contrary to popular belief, it appears that there… Continue Reading