iStock_000033418316_Medium-e1626470315777Increasingly, our healthcare and business law firm’s clients are interested in opening concierge medicine practices.  Hamil Little’s last blog post provided an overview of what concierge medicine is with references to compliance risks.  This post outlines those very serious compliance risks for practices that treat Medicare patients and are not opted out of Medicare.  If you have questions regarding this blog post or starting a concierge practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Understanding the compliance risks associated with concierge medicine practices requires understanding a fairly easy and, perhaps, obvious concept: Providers cannot bill patients for services paid for by their insurance; a practice referred to as “double billing.”  Applying that concept is easier said than done.  Consider the complexity in this: a concierge medicine practice requires a $200/month fee that includes “longer appointments,” which is a clear benefit to patients.  Assuming the appointment itself is covered by insurance, is the fact that it’s longer something that insurance does not cover?  Maybe, but maybe not.  There are ample examples of how complex this question is and, as it relates to Medicare, CMS and the Office of Inspector General (“OIG”) offer minimal guidance.

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new-practice-startup-01-1-300x225Both concierge medicine and direct primary care practices have become popular alternatives to the traditional insurance medical practice model.  In a previous post, we discussed direct primary care (“DPC”) practices, which are typically different from concierge medicine practices because DPC practices generally cut insurance companies out from the provider-patient relationship.  This post focuses just on concierge medicine practices, which generally offer members non-medical benefits while the patients, or their insurance companies, remain responsible for the cost of all office visits, medical services, medications, treatments, etc.  If you have questions regarding this blog post or starting a concierge practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Although many states have specific rules on direct primary care practices, it is less common that there are state rules governing strictly concierge medicine practices, which are also referred to as retainer-based or boutique medical practices.  A forthcoming blog post will discuss compliance risks to consider with concierge medicine practices.  This post answers a few preliminary questions about concierge medicine.

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Medicare-Money-square_7_0-300x300There are numerous adverse actions that can be taken against a provider’s Medicare ordering and referring or billing privileges.  In general, however, deactivation is not considered such an “adverse action” that will reflect on the providers PECOS; however, it does “stop” your ability to use your Medicare privileges.  If you have experienced an adverse action on your privileges, such as your privileges being revoked or excluded, please investigate yourself or call counsel to understand the rules and strict deadlines around what to do to preserve your right to appeal the decision.  This blog post covers “deactivation” only.  If you have questions regarding this blog post or wish to discuss your Medicare privileges, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

What is a Deactivation of Medicare Privileges?  

The Medicare code defines “Deactivate” as “the provider or supplier’s billing privileges were stopped but can be restored upon the submission of updated information.”  42 C.F.R. § 424.502.  Importantly, “[t]he deactivation of Medicare billing privileges does not have any effect on a provider’s or supplier’s participation agreement or any conditions of participation,” but “[a] provider or supplier may not receive payment for services or items furnished while deactivated.”  42 C.F.R. §§ 424.540(c), (e).   Generally, on PECOS, the deactivation will not appear as an adverse action, but may appear in the history tab.

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Medical-License-e1644515318522For various reasons, licensed medical providers may choose to voluntarily surrender their state medical license.  Earlier this year, our healthcare and business law firm blogged about the repercussions of voluntarily surrendering a state medical license on the physician’s Medicare enrollment.  Our firm recently had success in challenging a Medicare MAC’s decision to revoke a client’s Medicare enrollment based on a voluntary surrender of a medical license, resulting in the rescission of the revocation decision.  Another usually unexpected repercussion may also be ineligibility for Board examination or loss of Board Certification status.  Losing board certification or being found ineligible for board certification is a serious matter with potentially far-reaching adverse consequences. This post outlines the American Board of Internal Medicine’s (“ABIM”) eligibility rules and steps to challenge such a decision.  If you have questions regarding this blog post or wish to discuss an adverse decision by the ABIM or strategize ways to overcome an adverse decision, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

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tixeo-virtual-openspace-300x202Our healthcare and business law firm previously published a blog post on the federal telemedicine rules.  Both Federal and State rules govern the provision of telemedicine.  Each state’s rules governing telemedicine are different, but the applicable laws and rules are generally found in the state medical board’s rules, insurance code, and Medicaid rules.  This post focuses specifically on the telemedicine rules applicable to the practice of telemedicine in Georgia.  There are specific rules governing prescribing via telemedicine, which are not covered by this post.  If you have questions about telemedicine rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Georgia Insurance Code’s Definition of Telemedicine

The Georgia Composite Medical Board (“Medical Board”) generally requires an in-person exam, but the Medical Board Rules allow telemedicine in certain situations.  The relevant definition of “telemedicine” is found in Georgia’s insurance code and defines “telemedicine” as:

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MM-0220-Telemedicine-iStock-e1581381176331-1024x814-1-e1631301250783Given the increased use of telehealth during the Public Health Emergency (“PHE”), the Centers for Medicare and Medicaid Services (CMS) passed a final rule modifying the rules around when Medicare will reimburse for mental health visits.  A previous blog post analyzed Federal laws and rules governing telehealth visits, including the general Medicare rules applicable during the PHE.  This post analyzes the changes to the Medicare telehealth reimbursement rules for mental health treatment that begin the day after the PHE ends.  Note, there are different rules when treatment includes for substance abuse disorders.  If you have questions about telemedicine rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Essential Requirements Under Medicare’s New Rule

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4-e1647895403919Many of our healthcare and business law firm’s clients have an interest in offering a practice that offers more flexibility to patients when it comes to in-person versus virtual visits.  Deciding to offer telemedicine visits to your patients not only requires acquiring a video product that satisfies HIPAA and other privacy requirements but requires compliance with numerous laws at the state and federal level.  This post analyzes potentially relevant federal laws and rules that currently apply during the Public Health Emergency (“PHE”).  A subsequent post will provide an overview of state law considerations.  If you have questions about telemedicine rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

State laws provide the majority of laws and regulations governing telemedicine visits.  There are, however, two potentially relevant federal rules that a medical practice should consider before offering telemedicine: Medicare rules and the Ryan Haight Act. Continue reading ›

nurses-and-docs-300x240We have seen a continued growth in the popularity of medical spas despite the hurdles presented by the COVID-19 pandemic.  See Unpacking the Success Factors of the Medical Spa Industry During the Pandemic, Forbes (May 21, 2021).  Medical spas present unique compliance challenges from determining whether certain aesthetic services are considered the practice of medicine in the state to whether non-physicians can own the practice.  This blog post outlines 3 compliance questions every potential non-physician medical spa owner should ask. If you have questions regarding this blog post or need counsel navigating the complex rules and regulations for opening or operating a medical spa, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

  1. The procedures I plan to offer are aesthetic, so do I really need a physician involved?

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csm_FlatDesign-Telework_c532b56131-e1645230859515Previous blog posts provided an overview of the Centers for Medicare and Medicaid Services’s (“CMS”) Vaccine Mandate and addressed whether boosters are required. To continue supporting our healthcare and business law firm’s clients, herein we have tackled more specific questions about CMS’s Vaccine Mandate.   This blog post outlines CMS’s current stance on whether remote workers and executives are required to be vaccinated if the practice falls under CMS’s vaccine mandate. As always, the analysis herein is current as of the date this blog is posted and subject to change as agencies and courts release new decisions.

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Medical-License-e1644515318522For various reasons, licensed medical providers may choose to voluntarily surrender their state licensure.  Sometimes, the provider does not intend to work in the state anymore and no longer wishes to maintain the licensure.  Other times, the licensing agency may intend to discipline the provider and the provider chooses to surrender their license in lieu of receiving discipline.  Surrendering your license, however, may have unintended consequences to include revocation of your Medicare privileges and instituting a Medicare enrollment bar.  This post outlines what actions the Centers for Medicare and Medicaid (CMS) or one of its Medicare Administrative Contractors (MAC) may take in response to a provider surrendering their state licensure.  A forthcoming post will outline potential options a provider may have if their Medicare privileges have been revoked.  If you have questions regarding this blog post or wish to discuss your medical license or Medicare privileges, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

 

There are two main ways a CMS or a MAC can revoke a provider’s Medicare privileges after they voluntarily surrender their state medical licensure: Continue reading ›

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