The PROMETHEUS Payment(R) Model is a new program which is designed to pay providers fairly, improve quality, enhance transparency and still be more efficient than what we have today. At www.prometheuspayment.org, you will find much information about this not-for-profit, tax exempt program which has received more than $6 million from the Robert Wood Johnson
California Court Rejects Retroactive Credentialing Requirements
In Nasim v. Los Robles Regional Medical Center (2008 Cal. App. LEXIS 1251), a California Appellate State Court held that adoption of credentialing criteria which would retroactively deny a physician certain clinical privileges was illegal under California law.
Los Robles Regional Medical Center adopted standards requiring board certification, and those standards required that subspecialty board
Texas Reports Drop in Malpractice Premiums Due to Tort Reform With Damage Caps
Damage cap credited for drop in Texas malpractice premiums
BY CHRIS RIZO
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AUSTIN, Texas (Legal Newsline)-Thanks to a tort reform law in Texas, physicians in the Lone Star State will have reduced liability premiums, officials said this week.
The board of the Texas Medical Liability Trust recently approved an average rate reduction of 4.7
Stark IV: Per-Click Leases; Stand-in-Shoes; and Disallowance
The Department of Health and Human Services and Centers for Medicare and Medicaid Services (CMS) published final Stark IV regulations in the Federal Register on August 19, 2008. The web link is ttp://edocket.access.gpo.gov/2008/E8-17914.htm. The final regulations cover issues in addition to physician self-referral. Three issues of particular interest are the per-click compensation arrangements, the Stand-in-shoes regulations,
OIG Rejects Block Leasing Joint Venture
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.
HIPPA Administrative Simplification Proposed Rule
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
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)
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
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
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