Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Medical Spas
- medical billing
- No Surprises Act
- Mandatory vaccination policies
- Workplace health
- Coronavirus Aid, Relief and Economic Security Act
- Code Enforcement
- Department of Labor ("DOL")
- Employment Law
- FFCRA
- CARES Act
- Nursing Home Reform Act
- Acute Care Beds
- Clinical Support
- Coronavirus
- COVID-19
- Emergency Medical Services
- Emergency Preparedness
- Families First Coronavirus Response Act
- Family and Medical Leave Act (“FMLA”)
- KBML
- medication assisted therapy
- SB 150
- Department of Health and Human Services
- Legislative Developments
- Corporate
- United States Department of Justice ("DOJ")
- Employee Contracts
- Non-Compete Agreement
- Opioid Epidemic
- Sexual Harassment
- Health Resource and Services Administration
- House Bill 333
- Litigation
- Medical Malpractice
- Senate Bill 79
- locum tenens
- Senate Bill 4
- Physician Prescribing Authority
- Chronic Pain Management
- HIPAA
- Prescription Drugs
- "Two Midnights Rule"
- 340B Program
- EHR Systems
- Hospice
- ICD-10
- Kentucky minimum wage
- Minimum wage
- Primary Care Physicians ("PCPs")
- Skilled Nursing Facilities (“SNFs”)
- Uncategorized
- Affordable Insurance Exchanges
- Drug Screening
- Electronic Health Records (“EHR")
- Fraud
- Health Care Fraud
- HIPAA Risk Assessment
- KASPER
- Kentucky’s Department for Medicaid Services
- Mental Health Care
- Office for Civil Rights ("OCR")
- Qui Tam
- Stark Laws
- Urinalysis
- Accountable Care Organizations (“ACO”)
- Affordable Care Act
- Alternative Payment Models
- Anti-Kickback Statute
- Centers for Medicare & Medicaid Services (“CMS”)
- Certificate of Need ("CON")
- Compliance
- Data Breach
- Department of Health and Human Services (HHS)
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Federally Qualified Health Centers (“FQHCs”)
- Fee for Service
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Health Professional Shortage Area ("HPSA")
- Hospitals
- HPSA
- Kentucky Board of Medical Licensure
- Medicaid
- Medical Staff By-Laws
- Medically Underserved Area ("MUA")
- Medicare
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Part D
- Patient Protection and Affordable Care Act (“ACA”)
- Pharmacists
- Physician Assistants
- Rural Health Centers (“RHCs”)
- Rural Health Clinic
- Telehealth
- American Telemedicine Association (“ATA”)
- Charitable Hospitals
- Criminal Division of the Department of Justice (“DOJ”)
- Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)
- HRSA
- Kentucky Board of Nursing
- Limited Services Clinics
- Mid-Level Practitioners
- Qualified Health Care Centers (“FQHC”)
- Telemedicine
- APRNs
- Chain and Organization System (“PECOS”)
- Hydrocodone
- Kentucky Pharmacists Association
- United States ex. Rel. Kane v. Continuum Health Partners
- Webinar
- Agreed Order
- All-Payer Claims Database ("APCD")
- Chiropractic services
- Clinical Laboratory Improvement Amendments of 1988 (“CLIA”)
- Douglas v. Independent Living Center of Southern California
- Drug Enforcement Agency ("DEA")
- Emergency Rooms
- Enrollment
- Hinchy v. Walgreen Co.
- Jimmo v. Sebelius
- Kentucky Senate Bill 7
- Maintenance Standard
- Medicare Part D
- Minors
- Ophthalmological services
- Overpayments
- Physician Compare website
- Re-validation
- Texting
- Vitas Innovative Hospice Care
- 2014 Medicare Physician Fee Schedule (“PFS”)
- 501(c)(3)
- Affinity Health Plan
- Appeal
- Cadillac tax
- Centers for Disease Control and Prevention
- Chronic Care Management
- Community health needs assessment (“CHNA”)
- Compliance Officer
- Compounding
- CPR
- Denied Claims
- Dispenser
- Drug Quality and Security Act (“DQSA”)
- Essential Health Benefits
- Federation of State Medical Boards (“FSMB”)
- Food and Drug Administratio
- Form 4720
- Grace Period
- HealthCare.gov
- Home Medical Equipment Providers
- House Bill 3204
- ICD-9
- Individual mandate
- Kentucky Medical Practice Act
- Kindred v. Cherolis
- Kynect
- Licensure Requirements
- Long-term care communities
- Mobile medical applications ("apps")
- Model Policy for the Appropriate Use of Social Media and Social Networking in Medical Practice (“Model Policy”)
- National Drug Code ("NDC")
- National Institutes of Health
- New England Compounding Center ("NECC")
- Nonprofit hospitals
- Outsourcing facility
- Personal Service Entities
- Physician Payments
- Ping v. Beverly Enterprises
- Power of Attorney ("POA")
- Prescriber
- Qualified Health Plan ("QHP")
- Social Media
- Spousal coverage
- State Health Plan
- Sustainable Growth Rate (“SGR”)
- UPS
- "Plan of Correction"
- Advanced Practice Registered Nurses
- Arbitration
- Audit
- Business Associate Agreements
- Business Associates
- Call Coverage
- Condition of Participation ("CoP")
- Daycare centers
- Decertification
- Department of Medicaid Services’ (“DMS”)
- Division of Regulated Child Care
- Doe v. Guthrie Clinic
- EHR vendor
- Employer Group Health Plans
- Employer Mandate
- ERISA
- Fair Labor Standards Act (FLSA)
- False Billings
- Group Purchasing Organizations ("GPO")
- Health Professional Shortage Areas (“HPSA”)
- Health Reform
- Home Health Prospective Payment System
- Hospitalists
- House Bill 104
- Inpatient Care
- Intermediate Sanctions Agreement
- Kentucky Health Benefit Exchange
- Kentucky House Bill 217
- Licensed practical nurses (LPN)
- List of Excluded Individuals and Entities
- LLC v. Sutter
- Long-Term Care Providers ("LTC")
- Low-utilization payment adjustment ("LUPA")
- Meaningful use incentives
- Medicare Administrative Coordinators
- Medicare Benefit Policy Manual
- Medicare Shared Saving Program (MSSP)
- Network provider agreement
- Nonroutine medical supplies conversion factor (“NRS”)
- Nurse practitioners (NP)
- Office of the National Coordinator for Health Information Technology (“ONC”)
- Part A
- Part B
- Patient Autonomy
- Patient Privacy
- Payors
- Personal Health Information
- Physician Recruitment
- Physician shortages
- Provider Self Disclosure Protocol
- Quality reporting
- Registered nurses (RN)
- Residency Programs
- Self-Disclosure Protocol
- Statement of Deficiency ("SOD")
- Trade Association Group Coverage
- Upcoding
- “Superuser”
- Autism/ASD
- Center for Disease Control
- Compliance Programs
- Critical Access Hospitals (“CAHs”)
- Essential Health Benefits (“EHBs”)
- Genetic Information Nondiscrimination Act ("GINA")
- Healthcare Information and Management Systems Society (HIMSS)
- Kentucky House Bill 159
- Kentucky Primary Care Centers (“PCCs”)
- Managed Care Organizations (“MCOs”)
- Medicare Audit Improvement Act of 2012
- Recovery Audit Contractors (“RAC”)
- Senate Bill 39
- Senate Finance Committee Report
- Small Business Health Options Program (“SHOP”)
- State Medicaid Expansion
- Sunshine Act
- Abuse and Waste
- Consumer Operated and Oriented Plan programs (“CO-OPS”)
- Free Conference Committee Report
- Health Care Fraud and Abuse Control Program
- House Bill 1
- House Bill 4
- Kentucky Cabinet for Health and Family Services
- Kentucky Health Care Co-Op
- Kentucky Health Cooperative (“KYHC”)
- Kentucky “Pill Mill Bill”
- Occupational Safety and Health Administration (“OSHA”)
- Pain Management Facilities
- Employee Agreement
- Health Insurance
- Healthcare Regulation
- Health Care Law
McBrayer Blogs
Showing 65 posts from 2014.
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 >
