Articles Posted in Healthcare Information

iStock-1056799938-e1684354865672Both concierge medicine and direct primary care practices have become popular alternatives to the traditional insurance medical practice model.  Direct Primary Care (“DPC”) practices generally cut insurance companies out from the provider-patient relationship.  Medicare offers unique considerations because participating and non-participating providers maintain certain responsibilities regarding Medicare beneficiaries, and many providers are hesitant to “opt out” of Medicare.  With this post, we intend only to highlight a few points to consider before accepting private pay from Medicare beneficiaries outside of copays.  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.

 

Point 1- A Medicare-participating provider violates Medicare requirements by accepting private payment from a Medicare beneficiary for services that in whole or part constitute “covered services” as defined by Medicare.

Point 2- The federal Department of Health and Human Services (“HHS”) has established that requiring payment for non-covered services does not violate Medicare requirements. In fact, the HHS Office of Inspector General (“OIG”) states on its website: “It is legal to charge patients for services that are not covered by Medicare.”

Point 3- A complicating aspect of the seemingly simple rule is that whether a service is a “covered service” is determined solely by CMS, not by you.  Therefore, including language in a patient agreement such as “this fee does not cover any covered services”, though perhaps adequate to express an intention, does not prevent a practice/provider from being found to have violated Medicare rules. Continue reading ›

HIPAA-Breaches-Healthcare-Students-e1615468812558On April 11, 2023, U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced its plan to allow the Notifications of Enforcement Discretion issued under HIPAA and the HITECH Act during the COVID-19 Public Health Emergency (PHE) to expire on May 11, 2023.

Early on in the COVID-19 pandemic, the use of telehealth appointments increased dramatically in an effort to prevent the spread of COVID-19 as millions of doctors’ visits and health care examinations were often postponed or even canceled. OCR quickly recognized the critical need to assist the healthcare sector and the public in responding to this unprecedented crisis and in 2020 and 2021, published four Notifications of Enforcement Discretion in the Federal Register regarding how the Privacy, Security, Breach Notification, and Enforcement Rules under HIPAA would be applied to certain violations during the PHE. Continue reading ›

nurses-and-docs-e1681928313827Our healthcare and business law firm often assists physicians and other providers in obtaining and maintaining licensure.  Sometimes, physicians desire assistance to ensure a smooth process without having any occurrences to disclose.  The majority of the time, however, when we are hired to assist in licensure matters, the physician has a past or ongoing event that they need assistance with.  We usually begin by evaluating whether the occurrence must be, should be, or need not be disclosed.  One important question that is always present and concerning to many is the mental health question, which is also the first question on the Applicant Questionnaire section of the license application in Georgia.  There have been different iterations of this question over the years, and earlier this year, the Medical Board modified the questions once again.  This post explains the progression of this question in Georgia. If you need assistance applying for or maintaining licensure 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.

The mental health question on applications for licensure can be alarming to many physicians. Continue reading ›

Prepayment-Review-Shift-Blog-07-22-2016-e1681242443952Our healthcare and business law firm often assists medical practices in responding to medical record and coding audits initiated by private and governmental payors.  If a payor believes there are consistent concerns with a medical practice’s claims, the payor may place the practice under a prepayment review process.  This process can be very concerning to a practice and, in some cases, can place a practice at risk of shutting down.  A previous post provided an overview of standard claims processes versus a prepayment review process.  Prepayment review processes are different depending on which payor you are dealing with and whether the payor is private or government.  Herein, I provide a few tips for dealing specifically with TRICARE/Humana Military regarding a prepayment review process.  If you have questions about an insurance audit or prepayment review process 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.

In a previous blog post, I presented three tips for dealing with an audit from any payor.  Those tips remain relevant for trying to end a prepayment review with TRICARE/Humana Military.  The below tips are targeted specifically for dealing with a prepayment review process with TRICARE/Humana Military that is causing harm to your business due to the lack of claims being timely paid.

Tip 1: Get Your Community Liaison Involved

As a TRICARE provider, you have a Community Liaison that you can connect with via email and through the portal.  Your Community Liaison is there to answer your questions and connect you with the right people. Continue reading ›

self-employed-health-insurance-deduction-feature-1280x720-1-e1680719330392Our healthcare and business law firm often assists medical practices in responding to medical record and coding audits initiated by private and governmental payors.  If a payor believes there are consistent concerns with a medical practice’s claims, the payor may place the practice under a prepayment review process.  This process can be very concerning to a practice and, in some cases, can place a practice at risk of shutting down.  If you have questions about an insurance audit or prepayment review process 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.

Standard Claims Reimbursement Process

Generally, once a medical practice establishes a relationship with a payor, the practice can submit claims electronically that are paid without requiring individual review.  Generally, supporting documentation is not required to be submitted along with the claim. Continue reading ›

health-medical-e1680627379406Our healthcare and business law firm often assists medical practices in responding to medical record and coding audits initiated by private and governmental payors.  Responding to each payor is unique.  The way I might respond to a private payor may differ from how I respond to a government payor.  This post, however, provides a few tried-and-true tips to consider when faced with an audit.  If you have questions about an insurance audit 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.

Tip 1- Hire Counsel

Although this sounds self-serving, it is not.  Attorneys who are experienced assisting medical practices with responding to insurance audits are well worth their cost.  Continue reading ›

5061-dreamstime_m_28850408-e1680196937118Our healthcare and business law firm often assists provider and medical practice clients with preparing informed consents.  Many clients offer treatments in an off-label use and question whether informed consents are necessary for such use.  Currently, there is no FDA requirement to get a patient’s informed consent, but it may be beneficial for your practice to implement off-label informed consents.  If you have questions about patient consents 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.

What Does “Off Label” Mean?

Off label means providing treatment and prescribing medications for conditions or using a dose different than what the FDA has approved.  To become an approved use of a drug or treatment, the FDA must “conduct a careful evaluation of its benefits and risks for that use” and ensure that use “is supported by strong scientific data.”  Continue reading ›

MM-0220-Telemedicine-iStock-e1581381176331-1024x814-1-e1631301250783Our 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 or position statements, insurance code, and when applicable, Medicaid rules.  This post focuses specifically on the telemedicine rules applicable to the practice of telemedicine in Florida.  This post does not discuss telemedicine prescribing rules or Medicaid rules.  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.

Florida Rules

The Florida telehealth rules are set out in Florida Statute 456.47, which was modified in 2022 through Senate Bill 312.  Florida allows a limited telemedicine license for those without a full medical license, but, in general, the same rules apply regardless of whether a provider has a full medical license or limited telemedicine license. Continue reading ›

5G-icon-e1662133608419Our 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 codes, and when applicable, Medicaid rules.  This post focuses specifically on the telemedicine rules applicable to the practice of telemedicine in Tennessee.  This post does not discuss telemedicine prescribing rules or Medicaid rules.  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.

Tennessee Rules

Telemedicine is authorized in Tennessee and the rules governing telemedicine are found in the Tennessee Code and Tennessee Rules and Regulations.  Below is an overview of requirements currently in Tennessee governing the practice of telemedicine. Continue reading ›

iStock-1014086596-1000x500-2-e1661804634296Our 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 when applicable, Medicaid rules.  This post focuses specifically on Texas’s telemedicine prescribing rules.  Our firm previously posted an  overview of Texas’s general telemedicine rules.  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.

Texas Rules on Prescribing Based on a Telemedicine Visit

Texas’ rules governing telemedicine are found in the Texas Administrative Code and Texas Occupational Code.  Below is an overview of some requirements currently in Texas governing the practice of telemedicine. Continue reading ›

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