The Truth About Healthcare Regulatory Compliance

false claims act

medical practice complianceBy: Jeff Cohen

Healthcare regulatory compliance is too damn complicated sounding and scary!  What the heck does it even mean?  Basically it means making sure you’re following about a dozen specific laws, some of which interrelate.  It’s a little like making a cake.  You have to make sure you have flour, eggs, sugar and so on.  And then you have to make sure you put enough in the bowl and bake it at the right temperature.  So what’s so unique re healthcare regulatory compliance?  Healthcare professionals and businesses are inundated by these confusing laws written in legalese, to the point where they go numb.  They lose the ability to focus on them and to take them seriously.  And they hire someone that uses the word “consultant” or “compliance”; and they think they’ve got compliance covered.  But they don’t.  And that’s a big mistake in the healthcare world!Continue reading

Protecting Your License Against Adverse Action

election of rightsBy: Susan St. John

If you have ever been the recipient of a Florida state agency’s (i.e. Department of Health, AHCA, etc.) notice regarding an adverse action, such as a Notice of Intent to Deny, licensure application, renewal or change of ownership, you probably received an Election of Rights form along with the agency’s notice. The Election of Rights form must be completed and returned to the agency within 21 days of receiving the agency’s notice. In completing the Election of Rights form, you are given three options to choose from in deciding how you want to respond to the agency’s notice.

Under Option One you admit to the allegations of facts and law contained in the agency’s notice of intended action and waive the right to object and have a hearing. This is akin to an admission of guilt, that the agency is right in its decision, and you agree to a final order that supports the agency’s actions, including imposition of fines and punishment against you. Option One is generally not in your best interest.Continue reading

Telehealth Contract Review: How to Vet a Telehealth Opportunity

Providing telehealth services can be a worthy compliment to your practice; however, caution should be exercised before entering into a contractual relationship with a telehealth company. Keep in mind, when a telehealth company touts itself as “HIPAA compliant,” this is only one area where it must maintain compliance. It, along with the telehealth contract, must also be complaint with federal and/or state laws for furnishing telehealth services.

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Telehealth Practice Setup: 3 Easy Tech Steps

telemedicine practiceBy: Frank Diaz, Guest Contributor

Floridians are all too familiar with the business and logistical hurdles bad tropical weather can create. However, even less expected are the everyday human errors such as an overzealous backhoe operator digging above a fiber optic cable and inadvertently cutting a data connection. The reality is that disruption can happen anytime, not just during hurricane season. The good news is that recent developments in technology provide a new way to both augment the practice of medicine and insulate a business against downtime. Telemedicine or telehealth is rapidly becoming an inexpensive and secure way to interact with patients and medical professionals just short of the tactile response from pressing flesh during an introductory handshake.

Granted, telemedicine and telehealth are generic terms that incorporate layers of many technologies. For simplicity’s sake we’ll discuss some of the most popular options for video conferencing, cloud based technology and virtualization. If that sounds intimidating just look past the buzzwords you may hear in commercials mentioning a certain character from a Sir Arthur Conan Doyle novel. It’s all elementary. See what I did there?
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Medicare Telehealth Basics

Medicare TelemedicineBy: Susan St. John

If you are having issues with Medicare telehealth claim matters then you want to hire an experienced legal team that can guide you through the process, ensuring the best possible outcome. You also have the benefit of knowing that you are getting the best counsel for any legal matters and do not have to rely on amateur advisement like blogs and forums. These are some of the questions you can get answers to:

  • What experience do you have? When you hire an attorney to handle a legal matter for your business, you want them to be experienced and have a well established presence in this industry because there’s a chance they will be going up against insurance companies who have a lot of money and an experienced team of their own.
  • How can you help me with this situation? When you are dealing with this matter you want to make sure that everything is taken under consideration. For example, are you compliant with all the rules and regulations, new changes in policy or anything else that comes up? Do you have all the licensing you need to conduct business and so forth? An experienced team will make sure you have everything you need to move forward.
  • How can you help me in the future? One of the biggest advantages of hiring a law firm rather than an individual attorney is that we can assist you with several legal matters that come up in the future. Today you may need assistance with a contract for hiring a new doctor but a year from now it may be to purchase or sell a practice.

With the rise in services provided to patients via telehealth entities, it is important that both practitioners and patients understand what criteria must be met in order to provide and bill telehealth on behalf of Medicare patients. Here are a few of the basics.

First, “telehealth service” for Medicare purposes means “professional consultations, office visits, and office psychiatry services, and any additional service specified by the Secretary. To be eligible for payment, telehealth services must be rendered to an eligible individual, that is, an individual enrolled in Medicare, who receives telehealth services at an originating site from a physician or practitioner at a distant site via telehealth communications system. An eligible individual does not need to be presented by a physician or practitioner at the originating site to a physician or practitioner at a distant site, unless it is medically necessary. Determination of whether a presenting physician or practitioner is necessary at the originating site is made by the physician or practitioner at the distant site.

So, what is an originating site and what is a distant site?Continue reading

Resurgence of Medical Practice Acquisitions in Private Equity

telemedicine contract

medical practice saleBy: Jeff Cohen

Private money (e.g. private equity) is back chasing those selling medical practices and medical business acquisitions.  This time around it is very different from similar activity in the 90s.  Back then, the movement was public companies aggregating gross income dollars, which for a time drove stock prices.  Today’s private money buyers are looking to maximize profitability through achieving efficiency and aggregating large groups for leverage and the development of new income streams.  Though stock (in the form of warrants and options or stock itself) if often on the table, it doesn’t have to be.  Buyers are doing all cash deals, albeit to some degree on an earnings basis.  If you want the full price, you have to remain involved and do what you can to maintain revenues and perhaps even drive them up.

Physicians especially have to know what they’re dealing with and then have at least a basic understanding of the issues that will drive these deals.  To begin with, “private equity” simply means private investors (typically a group that pools their capital) that buy a portion or all of a company.  Their investments are usually much larger than venture capital firm deals.  They are not publicly traded entities.  What do they want?  To invest money in mature businesses, grow a company’s profitability and then “flip” their ownership to another buyer, typically in three to five years form their launch date.  In contrast, venture capital firms usually invest in start-ups, buy 100% of the company and require control.Continue reading

Billing & Telehealth Payment for Services in Florida

telehealth payment

telehealth paymentBy: Jacqueline Bain

Here in Florida, where large portions of the population are as transient as migrating birds, doctors and other practitioners often experience a downturn in their practice during the spring and summer months. However, telehealth provides these doctors and practitioners an option to continue treating their patients from afar, provided certain legal and technical requirements are met. The Federal Government and Medicare have been at the forefront of outlining how these services of the future may be properly rendered, allowing for continuity of care in a controlled setting. Medicare, for instance, pays for a limited number of Part B services furnished by a doctor or practitioner to an eligible Medicare beneficiary. To understand how to provide these services, doctors and practitioners must first learn the language.

Key Terms

An “originating site” is where the eligible Medicare beneficiary is located at the time the telehealth service is furnished. Originating sites may be physician offices, hospitals, rural health clinics, Federally Qualified Health Centers, Critical Access Hospitals, Skilled Nursing Facilities, and Community Mental health Centers. Medicare Administrative Contractors pay originating sites an originating site facility fee for telehealth services through HCPCS code Q3014.Continue reading

Medicare November Emergency Preparedness Deadline Quickly Approaching

By: Sharon Parsley 

It is not news that Hurricanes Harvey and Irma have rocked Texas and the Florida mainland, and Irma has left unimaginable damage throughout the Caribbean and Florida Keys.  During both hurricanes, considerable media attention was directed to how well hospitals and other sub-acute care providers in the affected areas were prepared for and responded to these events.  When coupled with the loss of multiple lives occurring at the Rehab Center at Hollywood Hills, seemingly due, at least in part, to exposure to extremely elevated temperatures during an extended power outage, emergency readiness should be near the top of every health care provider and supplier agenda.  Providers and suppliers should also be mindful of a rapidly approaching regulatory deadline Medicare requirement for continued participation on the topic of emergency preparedness.

While the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers regulation (the “EP Reg”) was published in the Federal Register in September of 2016, providers and suppliers falling into one of 17 categories are required to comply with the EP Reg on or before November 16, 2017.  Among those provider and supplier types affected are hospitals, ambulatory surgery centers, psychiatric residential treatment facilities, home health agencies, and certain clinics and rehabilitation service providers. Continue reading