Check David Harlow’s HealthBlawg ( http://healthblawg.typepad.com/) for a discussion of OIG Advisory Opinion 08-10, finding that a block leasing aggreement would be a prohibited joint venture.
August 2008
HIPPA Administrative Simplification Proposed Rule
By Michael Cassidy on
Posted in Compliance
On August 22, 2008 the Department of Health and Human Services published a Proposed Rule that would modify two of the medical data code set standards adopted in the Transactions and Code Sets final rule. The Proposed Rule would modify the standard code sets for coding diagnoses and inpatient hospital procedures by concurrently adopting…
Physicians Must Reimburse Hospitals and Medical Staff Officers for Successful Defense of Peer Review Claims
By Michael Cassidy on
Posted in Credentialing and Peer Review
Physicians initiating peer review litigation should be careful of two issues involving attorney’s fees. First, Section 42 USC 11113 of the Health Care Quality Improvement Act provides that hospitals may recover attorney’s fees from physicians who file frivolous or bad faith claims.
Second, sometimes the application for medical staff privileges contains clauses providing the immunity…
Key Points of Medicare Improvement for Patients and Providers Act of 2008 (MIPPA)
By Michael Cassidy on
Posted in Medicare & Reimbursement
1. Medicare Physician Fee Schedule. The sustainable growth rate (SGR) automatic physician compensation reduction of -10.6% was retroactively replaced with a .5% increase, essentially maintaining the .5% conversion factor increase implemented for January-June 2008.
2. Incentive Payments. Extends through 2010 incentive payments for implementation of electronic prescription systems (EPS).
3. Medicare Advantage Plan. …
CMS PROVIDES EVALUATION AND MANAGEMENT SERVICES GUIDE
By Michael Cassidy on
Posted in Medicare & Reimbursement
The CMS Medical Learning Network ("MLN") has posted an Evaluation and Management Services Guide for billing and coding. The Guide is a useful explanation of this complicated area and provides links to the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, as well as the Medicare Claims Processing Manual and the Current Procedure Terminology …
Peer Review Update: Adverse Peer Review Actions Require Independent Investigation
By Michael Cassidy on
Posted in Compliance
A California court has held that one hospital cannot take adverse peer review actions against a physician based solely on adverse peer review actions at another hospital; there must be an independent investigation of the medical issues.
In Smith vs. Selma Community Hospital, a copy of the opinion is attached below, the California appellate court…
The Importance of Medical Non-Compete Agreements
By Michael Cassidy on
Posted in Legal News
An Appellate Court in Tennessee recently held that a medical practice can enforce a medical noncompete agreement with a certified orthotist who took a job with a competitor due to the protectable interest that the practice had in the training that they provided to the employee who then acquired a specialized skill. The Court also …
Medlaw Blog Establishes New Record
By Michael Cassidy on
Posted in Legal News
I would like to thank all of the subscribers and users of the Medlaw Blog. July 2008 was a record setting month for the Medlaw Blog. We had more than 5,300 visits. We appreciate the support and welcome any suggestions you might have for content that you would like to see on Medlaw Blog.…