On May 1, 2009, health care providers will be subject to the "Red Flag Rules" issued by the Federal Trade Commission under the Fair and Accurate Credit Transactions Act. The Red Flag Rules apply to health care providers who allow patients to pay for health care services, for example through co-payments and deductibles, in installments.
Michael Cassidy
California Supreme Court Vindicates Dr. Mileikowsky
By Michael Cassidy on
Posted in Credentialing and Peer Review
The California Supreme Court vindicated Dr. Mileikowsky when it affirmed an appellate court decision setting aside the hospital’s governing board decision terminating Dr. Mileikowsky’s hearing and ordering the hospital to convene and conduct a new hearing in accordance with the medical staff bylaws.
The basis of the dispute was a ruling and action by the…
Highmark Issues Local Coverage Determinations (LCDs)
By Michael Cassidy on
Posted in Medicare & Reimbursement
Highmark has issued four new local coverage determinations, as follows:
- Intraoperative Neurophysiological Testing
- Sleep Disorders Testing
- Posterior Tibial Nerve Stimulation (PTN)
- Electromyography (EMG) and Nerve Conduction Studies
The following is the link of the full text of those LCDs: http://www.highmarkmedicareservices.com/policy/draft-status.html
OIG Open Letter Restricts Self-Disclosure Protocol
By Michael Cassidy on
Posted in Compliance
On March 24, 2009, the OIG issued an open letter (pdf) to healthcare providers restricting the application of the OIG Self-Disclosure Protocol (SDP).
The open letter states clearly that OIG is "narrowing the SDP’s scope regarding the physician’s self-referral law." This action has two components.
First, the OIG will accept providers into the SDP only when…
2009 Physician Enrollment Changes for Medicare Eliminates Retroactive Billing
By Michael Cassidy on
Posted in Medicare & Reimbursement
The 2009 Medicare Physician Fee Schedule made some changes regarding physician enrollment. The most significant change is the elimination of retroactive billing. Prior to the 2009 changes, Medicare permitted retroactive billing for up to 27 months following the effective date of a physician’s Medicare enrollment, to allow physicians to bill for services that they provided while the…
California Enforces Anti-SLAPP Against Physician
By Michael Cassidy on
Posted in Credentialing and Peer Review
The Court of Appeals for the State of California has overruled a trial court decision holding a summary suspension was not a formal proceeding entitled to Anti-SLAPP protection. In Arunasalam v. St. Mary Medical Center, Dr. Arunasalam was summarily suspended for disruptive conduct and sought a Medical Staff Hearing, but the Medical Staff Hearing was…
COBRA SUBSIDY – DOL ISSUES MODEL NOTICES
By Michael Cassidy on
Posted in Uncategorized
Today, the U.S. Department of Labor (“DOL”) issued model notices reflecting the recently enacted COBRA subsidy requirements and also issued updated FAQs on how the COBRA subsidy provisions are to work. View the model notices and FAQs. A summary of the different model notices (taken from the DOL’s descriptions) is below.
General Notice (Full version)…
April 1, 2009 Starts New Compliance Obligations For Group Health Plans Under The Children’s Health Insurance Program Reauthorization Act Of 2009
By Michael Cassidy on
Posted in Uncategorized
Although group health plan sponsors are busy focusing on the COBRA subsidy enacted this past February, there are a flurry of laws impacting group health plans that have compliance dates ranging from April 2009 to February 2010. One of the laws, “The Children’s Health Insurance Program Reauthorization Act of 2009”, also enacted in February …
Medicare Approves Sleep Testing for Obstructive Sleep Apnea (OSA)
By Michael Cassidy on
Posted in Medicare & Reimbursement
On March 3, 2009, CMS published the "Decision Memo for Sleep Testing for Obstructive Sleep Apnea." A summary of the decision follows:
"CMS finds that the evidence is sufficient to determine that the results of the sleep tests identified below can be used by a beneficiary’s treating physician to diagnose OSA, that the use of such…
Pennsylvania Bar Institute Seminar – COBRA
By Michael Cassidy on
Posted in Uncategorized
Today, David Sawyer of Tucker Arensberg, P.C. will be leading a call-in seminar for the Pennsylvania Bar Institute (PBI) regarding the recent COBRA changes. Register for the live seminar (which is from 12:30-1:30).
You also may register to listen to the seminar through the internet after its live broadcast by following the same link. Written materials…