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Provider Self Disclosure Process

Posted on May 22, 2014 by

A growing area of the health care legal practice involves counseling clients on issues that could require self disclosure under OIG or CMS procedures. The Office of Inspector General has procedures that a provider may follow to disclose possible violations of the Anti-Kickback Statute or other federal laws. Providers have the opportunity to avoid much […]

Jointly Providing Health Care Fee Information to Payors

Posted on May 22, 2014 by

As health care provider networks move down the path toward clinical integration, we are often asked to provide guidance on how information can be jointly provided to payors. The antitrust laws recognize that collective sharing of some pricing information, even by otherwise competing providers, can be beneficial and does not necessarily violate antitrust laws. However, […]

CMS Changes Meaningful Use Timeline

Posted on May 21, 2014 by

The Centers for Medicare and Medicaid Services (CMS) issued a new proposed rule today that changes the timeline for meaningful use electronic health record (EHR) technology. The new proposed rule would be consistent with previous CMS announcement regarding extension of Stage 2 and Stage 3 timelines. The proposed rule recognizes the difficulties that software vendors […]

OIG Proposes New Civil Monetary Penalty Rules

Posted on May 19, 2014 by

On May 12, 2014, the Office of Inspector General (OIG) published a proposed rule that would amend the civil monetary penalty (CMP) rules of the OIG to incorporate new CMP authorities, clarify existing authorities, and reorganize regulations on civil money penalties, assessments, and exclusions. The proposed regulations are intended by the OIG to update regulations […]

Messenger Model Contracting – A Structure of the Past

Posted on May 19, 2014 by

There are many organizations around the country that use a messenger model as a managed care contracting mechanism. Under the messenger model, an intermediary is used to shuttle offers from managed care organizations to individual providers who sign on to the network. Messenger model networks should not be confused with clinically integrated systems. Clinical integration […]

Self Disclosure and Repayment: Employment of Excluded Party

Posted on May 19, 2014 by

One area it is relatively common to find compliance infractions involves the employment of individuals by a health care provider who may be listed on the list of parties who are excluded from federal health care programs. Most providers have integrated routine background checks and excluded party searches into their hiring program. Occasionally, an excluded […]

Electronic Health Records Donation – Final Rules Issued by Centers for Medicare & Medicaid Services and Office of Inspector General

Posted on January 2, 2014 by and

Just before the current rule was due to expire, the Centers for Medicare & Medicaid Services (CMS) on December 27, 2013 released final regulations on donation of electronic health record software. The existing rule, which was set to expire on December 31, 2013, allowed hospitals and other providers of Stark Law “designated health services” to […]

Final Regulations Issued Under the HITECH Act

Posted on January 24, 2013 by and

A final rule containing a wide range of changes to the privacy and security provisions of HIPAA was released last Thursday (January 17, 2013) by the Department of Health and Human Services Office for Civil Rights (OCR). The final regulations include a variety of implementing provisions for three primary rules that were required by the […]

Physician Pay Cut Avoided By the Fiscal Cliff Legislation

Posted on January 7, 2013 by

Physicians can breathe a sigh of relief for at least another year. The “fiscal cliff” legislation that was passed by Congress on New Year s Day and signed by President Obama Wednesday night (January 2, 2013) averted the planned cut in Medicare payments for physicians that were scheduled to take place on January 1, 2013. […]

OIG Approves Per Diem Payments to Physicians for On-Call Coverage

Posted on October 31, 2012 by

Payment for call coverage has become a major issue throughout the country as physicians are increasingly asking for payment for providing call availability. Traditionally, call coverage has been seen as part of the physician’s medical staff obligation. However, physicians are beginning to question traditional “on-call” coverage obligations for a number of reasons, including the fact […]