Medicaid Fingerprinting Requirements
via PBCMS medlink available at www.pbcms.org 
There has been some recent confusion about the new Medicaid requirement for providers to have their fingerprints done. AHCA recently distributed a memo on the requirement which states:
409.907 (8)(a), F.S., requires all initial or renewing provider applicants to Florida Medicaid to submit fingerprints for purposes of obtaining a criminal history record check unless they meet one of the exemptions as described in the statute.
All physicians do NOT need to go out and get their fingerprints done immediately. The ONLY physicians this applies to are those who are initially applying as a Medicaid provider or renewing their provider application. At that time, a provider will be required to submit his or her fingerprints with the application.
Appeals Court Strikes Down Individual Mandate in Reform Law
Via Modern Healthcare, Joe Carlson
In a 304-page opinion, the 11th U.S. Circuit Court of Appeals in Atlanta on Friday struck down the individual insurance mandate in the Patient Protection and Affordable Care Act, but allowed the rest of the sweeping law to stand.
In its decision, a divided three-judge panel of the federal appeals court ruled in favor of 26 states that had joined a lawsuit in Pensacola, Fla., which argued the reform law should be struck down because it relies on an unconstitutional expansion of federal power.
The ruling means that the Supreme Court will now have the classic split in the circuit courts that it often relies on when deciding whether to take on a case. The 6th Circuit Court of Appeals upheld the law in June, and the losers in that case filed for permission last month to have their case heard by the Supreme Court.
Read more: http://www.modernhealthcare.com/article/20110812/NEWS/308119930#ixzz1VCtydEqc
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Marketing: Boldly Going Where No Practice Has Gone Before
By now, every physician has learned about ACOs, Super Groups, IPAs and the like. Virtually every “new” acronym and idea has revealed itself as a retread old one, so at least physicians are getting more comfortable with the new language of healthcare reform. And they are accepting that no one really knows what’s going to happen and how medical practice will ultimately be years from now.
Nearly every physician has asked in the past year or so “What do I do now?” And they have heard responses from every vendor which translates into “Buy my stuff.” Ask an IT person what to do…”Buy my stuff.” Ask an EMR person what to do…”Buy my stuff.” Ask a lawyer….ok enough.
What to do and when to do it in light of feared changes in healthcare is anyone’s guess. There is, however, one remarkably overlooked area of business which physicians have traditionally neglected and which they must focus on now more than ever—marketing.
Do you have a website? Do you know what SEO is and how it works? Do you believe that patients buy what you do and not just who you are? In the internet age when people buy mattresses online, sight unseen, physicians have to begin to learn about marketing.
Though years ago, practicing medicine was clearly a profession, it is now big business. And physicians who thrive will be those who embrace business practices, including marketing. This takes a huge shift in perception since most physicians look at marketing as an expense, not as a good investment.
If you were told that every dollar invested in marketing will yield five dollars in new business would you spend the money? If you were told that buying a stock will result in a five-fold yield over twelve months, would you invest? Physicians have to look as marketing as a good investment rather than simply as a cost. And those that do will likely grow and thrive.
Elephants in the Room
ACOs and other new acronyms have swamped the minds of physicians and healthcarebusiness people alike since the terms were coined. The still new healthcare reform law continues to worry many and challenge others to figure out ways to play the game and win. While we scurry around chasing the regs and the new words and government agencies, while politics keeps moving the ball and shaping the healthcare agenda, the most central issues in healthcare cost/quality debate are not even discussed. It’s as though policy makers and business is saying “Hey, if we keep throwing new regulations at them, maybe they’ll stop asking really tough questions we can’t answer.”
Back in the 80s, the state of Oregon enacted Medicaid reform that took the breath right out of the rest of the country. Remember? The idea that a state would not list ALL medical services to ALL Medicaid patients was considered to be cruel and impolitic at the time. And the national debate about (1) whether healthcare is a right of American citizens, and if so (2) what healthcare services are “in” and which are “out” has grown virtually silent.
Instead, it seems we have entered the area of political intransigence. It appears that getting and staying in political office requires as little change as possible. So, very little seems to be accomplished or even discussed.
So what are the “elephants in the room?” They are the issues of “how much” and “patient accountability.” Though it appears that the issue of whether we Americans are entitled to receive healthcare has been skirted, we are clearly missing any discussion on the issue of how much services. Oregon hit the issue head on, but nationally there appears to be no movement or even discussion of the issue. We don’t know who should get what. We just know we want to reduce the costs (ration).
Virtually every effort to reduce costs so far has involved the use of managed care organizations. The Florida Medicaid program pilot project that began in Broward County in 2006 has produced two clear results—reduced expenditures and huge criticism that managed care has reduced costs solely by reducing access and care itself. Managed care has become the “black hat” that politics won’t pick up. It’s ok for managed care to restrict access and care because it reduces costs, but it is politically impossible to directly address the issue of “how much.” We rely on managed care to do it for us, due to our political inability to tackle the issue, then blame the payers for their (wink wink) bad behavior. If managed care is profiting, it is only because they don’t mind profiting from our unwillingness to take responsibility for the issues they deal with on a daily basis—saying “no.”
The second elephant is the issue of patient accountability. There is none! What is the consequence of patient bad behavior? What consequence is there for refusal to exercise, quit smoking, etc.? None. We pay more. There isn’t a single provision in any federal law that punishes us for making expensive healthcare decisions or that rewards us for making cost saving healthcare decisions.
I liken it to having teenagers. Expectations with no consequences yields a predictable result of no change in behavior. Simple.
These are huge issues to tackle. So many different kinds of people, agendas and ways of seeing the issues. So, we don’t even try. Instead, we “hire” managed care to bear the burden of our failure to address and answer these issues. And we throw complex ideas like metrics and healthcare reform into the market, which only serves to distract us from addressing the root causes of our healthcare challenges.
Norton and Humana Commercial ACO Moving Forward
Jim Molpus, for HealthLeaders Media, August 8, 2011
“In its most simplified form, the idea behind accountable care organizations was to get the healthcare providers and payers in a community to work together to improve care while also reducing its cost. Much of that purity has been lost in the noise of the ACO movement, but in Louisville, KY, Norton Healthcare and Humana are continuing the journey.
Norton, with five hospitals and more than 2,000 physicians, and health plan Humana, headquartered in Louisville but with 10 million members nationwide, began discussions of forming an ACO in 2009, “when we had no idea what an ACO really was,” says Steven Hester, MD, Norton’s chief medical officer.”
Medical Practice Healthcare Legal Audit
The Florida Healthcare Law Firm is proud to offer to our latest service – The Medical Practice Healthcare Legal Audit
Why have an audit?
State and federal regulators are investing billions to enforce even the most benign violations. We have seen what appears to be an honest, simple mistake lead to investigations by regulatory agencies and the imposition of monetary fines and penalties. The sting of any regulatory sanction is further compounded due to lost patient revenues from your practice because of the time and worry dedicated to dealing with government regulators. The end result is the need to spend tens of thousands of dollars, or more, of attorney fees and consulting fees to help undo the damage. Prevention is better than cure!
How it works:
Our Medical Practice Healthcare Legal Audit is comprehensive and can be performed on site at your facility for your convenience. We will conduct interviews with key staff and take a complete top-to-bottom look at your practice to determine if there are any issues that may cause exposure to actions by various regulatory bodies. In addition to identifying risk areas, we will also look for missed revenue opportunities that you may not be taking advantage of if you are unaware of certain key terms in an agreement. Depending on your individual situation our review can cover the following issues:
State licensing boards
Employment contracts
Managed Care Contracts
Medicare
Medicaid
State and Federal fraud and abuse laws
Vendor agreements
Equipment leases
Employment Practices to include: wage and hour compliance (overtime); eeoc compliance; employee handbook; proper classification of employees (exempt vs non-exempt); hiring and termination of employees
OHSA
DEA
Other applicable regulatory issues
What you get:
Once our review is completed we will provide you with a written report of our findings and suggest an action plan for correcting any items that we think may expose your practice. Additionally we can develop for your practice a complete compliance program; your guide to ensuring continued compliance. Did you know that having a written compliance program can be a mitigating factor in the assessment of fines and penalties by many regulatory agencies?
Call now to discuss how our Medical Practice Healthcare Legal Audit can help steer your practice in the right direction. We can tailor the audit to meet your specific needs and provide it at a convenient and reasonable flat rate.
Innovative Surgery Center Arrangements
While surgery centers generally follow the guidelines set forth in the federal Safe Harbor to the Anti Kickback Statute (AKS), not all do. In fact, there are some creative arrangements worth considering.
Some centers do not perform services which are compensated in any way by a state or federal healthcare program. As such, they don’t have to comply with the usual federal laws (e.g. AKS and Stark). That leaves the center to comply only with state regulation, which is usually far less restrictive than the federal laws. This works if the center intends, for instance, only to do work pursuant to Letters of Protection (LOP) or bodily injury suits. Though the pool of patients is very different in this type of center, the lid is nearly off when it comes to how creative the arrangements among the owners and referring physicians can be.
One of the more vexing challenges among all surgery centers is ensuring patient referrals by owner surgeons. While most centers will simply follow the federal Safe Harbor “one third test,” other centers go further and do things like: (1) making loans to owner surgeons, (2) creating “put” or “pull” periods during which time an investing physician can buy back out or be bought back out, and (3) even making exceptions to the restrictive covenants commonly contained in ASC documents.
Complying with the federal Safe Harbor applicable to surgery centers is clearly the most conservative way to go, in terms of regulatory compliance, since compliance means immunity from AKS violations. That said, Safe Harbor compliance is a little like horseshoes: coming close counts. The simple reason is that Safe Harbors are examples of conduct that complies with the AKS, but they are not all encompassing. There may be arrangements that do not violate the AKS which are simply not described in the Safe Harbors. Simply put, there are many other creative arrangements commonly employed in surgery centers. Since surgery center ownership and referral arrangements are hotly regulated, owners must be careful when considering veering off the straight course provided by federal law.
Clinical Research Organizations (CROs) and Referring Physicians
The two business drivers of CROs are (1) pharmaceutical companies that want studies, and (2) referring physicians. Though CROs will enter into advertising programs designed to educate and attract study participants (often paid for by Pharma), CROs are often frustrated in generating community physician referrals. One of the main obstacles is the federal Anti Kickback Statute (AKS), which forbids payment of any kind in exchange for patient referrals. CROs will be glad to know, however, that one of the AKS regulatory exceptions (Safe Harbors) in particular, the “Personal Services Exception” does allow CROs to enter into compensation arrangements with referring physicians. Though the purpose cannot be to induce patient referrals, if the Safe Harbor is complied with, the CRO can have a compensation arrangement with a physician who refers.
The Safe Harbor essentially requires the following:
- That the arrangement be for necessary services (not some cloaked way to pay for patient referrals);
- The doctor’s duties have to be in writing;
- There has to be a written agreement between the parties;
- The agreement must have a 12 month term (though it could be terminated within that period of time);
- Compensation must be set in advance, be consistent with fair market value and not vary based on the value or volume of business between the CRO and the referring doctor.
Important FDLE Notice
We have received notice from the Florida Department of Law Enforcement (FDLE) regarding a planned upgrade to the system used to process criminal history screening requests. In order to transition to the upgraded system, FDLE will not be able to accept electronic (LiveScan) submissions during the conversion.
Therefore, LiveScan vendors will not be able to process or submit fingerprints to FDLE beginning Thursday, July 21st at 11:00 a.m. They expect to resume services the afternoon of Monday, July 25th. Please keep this in mind as you schedule employees and potential employees for Level 2 screening.
Please note that the FDLE upgrade may also cause delays in the Agency’s processing time for making screening determinations.
