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5 Jan 2016, 6:11 am by Todd Rodriguez
This week the Office of Inspector General (OIG) published Advisory Opinion 15-16 addressing a 501(c)(3) charitable foundation (the “Requestor”) that would seek donations from third parties (including drug manufacturers) and provide financial assistance with out-of-pocket patient expenses for outpatient prescription drugs. [read post]
31 Dec 2015, 10:22 am by Todd Rodriguez
Earlier this month, the Centers for Medicare and Medicaid Services released a new tool designed to give providers and consumers insight into Medicare drug spending. [read post]
31 Dec 2015, 10:22 am by Todd Rodriguez
Earlier this month, the Centers for Medicare and Medicaid Services released a new tool designed to give providers and consumers insight into Medicare drug spending. [read post]
30 Dec 2015, 6:58 am by Todd Rodriguez
This week, the Office of Inspector General (OIG) issued OIG Advisory Opinion No. 15-15 regarding a proposed arrangement in which a hospital would bill a radiology group for transcription of the radiology group’s reports for patients who are not hospital patients, but rather patients of a third-party clinic that provides radiology studies and refers to the radiology group. [read post]
29 Dec 2015, 10:21 am by Todd Rodriguez
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. [read post]
28 Dec 2015, 8:10 am by Todd Rodriguez
The Centers for Medicare & Medicaid Services (CMS) has stated its intention to move at least 50% of Medicare payments from fee for service to alternative payment systems based on quality and/or value by 2018. [read post]
22 Dec 2015, 6:25 am by Edward J. Cyran
Commercial payors are actively looking for ways to reduce payments to out-of-network providers. [read post]
21 Dec 2015, 6:47 am by Todd Rodriguez
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. [read post]
21 Dec 2015, 6:47 am by Todd Rodriguez
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. [read post]
13 Nov 2015, 6:16 am by Todd Rodriguez
This past month, CMS published several new Frequently Asked Questions  (FAQs) on its website addressing questions about the EHR incentive programs, and in particular how to attest to certain measures for health information exchange, patient electronic access, and other objectives that require patient action. [read post]
9 Nov 2015, 7:49 am by Edward J. Cyran
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. [read post]
19 Oct 2015, 7:13 am by Edward J. Cyran
A new article in the online journal, JAMA Internal Medicine, highlights the importance for physicians of keeping valuable non-public information confidential. [read post]
6 Oct 2015, 11:27 am by Edward J. Cyran
The long-anticipated implementation of ICD-10 coding finally began this past Thursday, October 1, 2015. [read post]
18 Sep 2015, 8:25 am by Edward J. Cyran
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 an express right to sue a physician for failing to report such abuse under the PA Child Protective Services Law (the “Child Abuse Law”). [read post]
31 Aug 2015, 10:15 am by Edward J. Cyran
Pennsylvania’s Child Protective Services Law received a major overhaul after the Penn State child abuse scandal. [read post]
14 Aug 2015, 12:37 pm by Edward J. Cyran
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 institutional providers, the overpayment must be returned by the later of 60 days or the date on which a corresponding cost report is due to the… [read post]
29 Jul 2015, 12:13 pm by Todd Rodriguez
According to a recent study published by Accenture, only 1 in 3 physicians will be in independent private medical practice by 2016. [read post]
28 Jul 2015, 2:49 pm by Todd Rodriguez
The Office of Inspector General (OIG) of the Department of Health and Human Services posted an Advisory Opinion today addressing a hospital system’s proposal to lease administrative employees and to provide operational and management services to a related psychiatric hospital for an amount equal to the hospital system’s fully loaded costs (i.e., salary plus benefits and overhead expense) plus a two percent administrative fee). [read post]
20 Jul 2015, 5:12 am by Edward J. Cyran
You may have heard that CMS recently expanded its authority to deny enrollment and revoke the Medicare billing privileges of providers and suppliers. [read post]
30 Jun 2015, 10:34 am by Todd Rodriguez
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. [read post]