At the conclusion of their residency or fellowship, physicians are faced with the new challenge of interviewing and negotiating their first contract. One of the first things that I hear from early career physicians who reach out to me is that while they have spent years learning and developing complex medical skills, they feel lost … Continue Reading
The final “2023 Omnibus Bill” which is the spending bill passed by Congress and signed by President Biden at the end of 2022, provides partial relief from the scheduled Medicare Physician Fee Schedule Conversion Factor cuts. As previously reported, the changes to the Medicare Physician Schedule Conversion Factor would have reduced physician reimbursement by 4.5%. … Continue Reading
Both the federal government and the Pennsylvania state government are taking steps to reform the prior authorization process. Take a look at the Pennsylvania Insurance Department press release that was issued November 3, 2022, touting the passage and signing of Pennsylvania Act 146, which is described as creating a new and more effective process for prior authorization … Continue Reading
The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”. The alert is based upon OIG’s perception that these Telemedicine Companies are engaged in schemes to … Continue Reading
On July 7, 2022, CMS released its proposed Medicare Physician Fee Schedule for 2023, which proposes physician fee schedule reductions via the Medicare Conversion Factor. The general Medicare conversion factor will be reduced by 4.4% from $34,61 to $33.08 The anesthesia conversion factor will be reduced 3.9% from $21.56 to $20.72 The link is attached … Continue Reading
Mike Cassidy recently wrote an article entitled, “Private Equity Deals Offer Both Potential Significant Return and Significant Challenges” in the Legal Summary section of the July 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to … Continue Reading
Jeremy Farrell and Rebecca Moran recently wrote an article entitled, “Pregnancy-Related Protections for New Physicians” in the Legal Summary section of the June 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to read the article … Continue Reading
The Cyber Incident Reporting for Critical Infrastructure Act (CIRCIA), was passed as part of the consolidated Budget Act for 2022, which also included the telehealth provisions I posted about last week. The definition of “covered entity” in the Act is far greater than covered entity as defined by HIPAA. Covered entity as per CIRCIA includes … Continue Reading
HHS sent notices to noncompliant physicians and facilities on March 10, 2022 giving them 30 days to return funds paid to healthcare providers who have not complied with the agency’s reporting requirements. Attach is the PDF from HRSA (Health Resources and Services Administration), which is the agency responsible for dispensing and collecting the grant money. … Continue Reading
The President and Congress extended Medicare telehealth coverage in the Consolidated Appropriations Act, which also included additional Ukrainian relief. On Tuesday, March 15, 2022, President Biden signed the Consolidated Appropriations Act, 2022 (“2022 CAA”). This new law includes several provisions that extend the Medicare telehealth waivers and flexibilities, implemented as a result of COVID-19 to … Continue Reading
Highmark Health issued a Press Release on February 7, 2022 announcing that it’s Financial Investigations and Provider Review (FIPR) department generated more than $245 million in savings related to fraud waste and abuse in 2021, the majority of which was in Pennsylvania–$184 million. Click here to see to what the Highmark FIPR Department has identified … Continue Reading
There has been much discussion and controversy over the new CMS position on billing for split/shared services in facility settings. As originally proposed, and starting in January 2022, if the service was shared among providers (such as physicians and physician assistants), the provider who performed the substantive portion of the visit would be the provider … Continue Reading
There is almost universal agreement regarding predictions for 2022 federal enforcement in the following areas: The use of fraudulently obtained COVID relief funds in both healthcare and in general, but specifically as a foundation for False Claims Act enforcement. Furthermore, the reinstatement of the Yates memo of 2015 by the Deputy Attorney General Lisa Monaco’s … Continue Reading
Under the Federal Ethics in Patient Referrals Act (more commonly known as “Stark”), if a physician[1] has a financial relationship with an entity, the physician may not refer patients to the entity for medical services payable by Medicare unless the financial relationship complies with the Stark safe harbors. Thus, entities that lease or sublease space or … Continue Reading
In MLN Matters article MM 12159, CMS has published summaries of the following: Updates to payment policies and Medicare payment rates for services provided by physicians and non-physician practitioners (NPP) Updates to Medicare telehealth services and telehealth originating site facility fee payment amounts Billing for a physician assistant (PA) services … Continue Reading
Mike Cassidy will be one of the panelists discussing “The Myths About Telehealth: Telefraud vs. Telemedicine Fraud” at the virtual CTeL Digital Health Summit on Thursday, December 16, 2021.… Continue Reading
CMS has announced a delay to implementation of PECOS Multi-Factor Authentication in the MLN Connects publication on Thursday, December 9, 2021: 2021-12-09-MLNC | CMS. This is a link to the publication and in the link you will find links to the PECOS announcements.… Continue Reading
A recent Wall Street Journal article in their “The Future of Everything” commentary stream discusses the use of artificial intelligence (AI) to “tap the treasure trove of information locked in electronic health records to treat people in real time”. An interesting concept. Not all that long ago this would have been disparaged as “cookie-cutter medicine”. … Continue Reading
The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule requiring COVID-19 vaccinations for workers in most institutional care settings. A copy of the CMS press release can be found at https://www.cms.gov/newsroom/press-releases/biden-harris-administration-issues-emergency-regulation-requiring-covid-19-vaccination-health-care. This rule applies to those facilities subject to CMS regulations. Several facilities are regulated by the CMS, but this does … Continue Reading
The Pennsylvania Senate announced on October 26, 2021 that it has passed Senate Bill 705, and a copy of the Senate Press Release can be found at https://www.pasenategop.com/blog/senate-approves-telemedicine-bill/. A previous telemedicine bill was passed in Pennsylvania in July of 2018, when the Pennsylvania Senate approved Bill 780, which was discussed in my MedLaw Blog article … Continue Reading
