Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Coronavirus Aid, Relief and Economic Security Act
- Code Enforcement
- Department of Labor ("DOL")
- Employment Law
- FFCRA
- CARES Act
- Nursing Home Reform Act
- SB 150
- COVID-19
- Families First Coronavirus Response Act
- Family and Medical Leave Act (“FMLA”)
- KBML
- medication assisted therapy
- Acute Care Beds
- Clinical Support
- Coronavirus
- Emergency Medical Services
- Emergency Preparedness
- Department of Health and Human Services
- Legislative Developments
- Corporate
- United States Department of Justice ("DOJ")
- Employee Contracts
- Non-Compete Agreement
- Opioid Epidemic
- Sexual Harassment
- Health Resource and Services Administration
- Litigation
- Medical Malpractice
- House Bill 333
- Senate Bill 79
- locum tenens
- Senate Bill 4
- Physician Prescribing Authority
- Chronic Pain Management
- HIPAA
- Prescription Drugs
- Kentucky minimum wage
- Minimum wage
- Uncategorized
- "Two Midnights Rule"
- 340B Program
- EHR Systems
- Hospice
- ICD-10
- Skilled Nursing Facilities (“SNFs”)
- Electronic Health Records (“EHR")
- Primary Care Physicians ("PCPs")
- Drug Screening
- Mental Health Care
- Urinalysis
- Affordable Insurance Exchanges
- Fraud
- Health Care Fraud
- HIPAA Risk Assessment
- KASPER
- Kentucky’s Department for Medicaid Services
- Office for Civil Rights ("OCR")
- Qui Tam
- Stark Laws
- Compliance
- Department of Health and Human Services (HHS)
- Federally Qualified Health Centers (“FQHCs”)
- HPSA
- Kentucky Board of Medical Licensure
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Pharmacists
- Physician Assistants
- Rural Health Centers (“RHCs”)
- Telehealth
- Accountable Care Organizations (“ACO”)
- Affordable Care Act
- Anti-Kickback Statute
- Centers for Medicare & Medicaid Services (“CMS”)
- Certificate of Need ("CON")
- Data Breach
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Fee for Service
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Hospitals
- Medicaid
- Medical Staff By-Laws
- Medicare
- Part D
- Patient Protection and Affordable Care Act (“ACA”)
- Alternative Payment Models
- Charitable Hospitals
- Health Professional Shortage Area ("HPSA")
- HRSA
- Limited Services Clinics
- Medically Underserved Area ("MUA")
- Mid-Level Practitioners
- Rural Health Clinic
- American Telemedicine Association (“ATA”)
- Criminal Division of the Department of Justice (“DOJ”)
- Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)
- Kentucky Board of Nursing
- Telemedicine
- Hydrocodone
- Kentucky Pharmacists Association
- Qualified Health Care Centers (“FQHC”)
- United States ex. Rel. Kane v. Continuum Health Partners
- Webinar
- APRNs
- Chain and Organization System (“PECOS”)
- Jimmo v. Sebelius
- Maintenance Standard
- Overpayments
- Vitas Innovative Hospice Care
- Agreed Order
- Douglas v. Independent Living Center of Southern California
- Drug Enforcement Agency ("DEA")
- Emergency Rooms
- Enrollment
- Hinchy v. Walgreen Co.
- Kentucky Senate Bill 7
- Medicare Part D
- Minors
- Re-validation
- All-Payer Claims Database ("APCD")
- Chiropractic services
- Clinical Laboratory Improvement Amendments of 1988 (“CLIA”)
- Compliance Officer
- ICD-9
- Ophthalmological services
- Physician Compare website
- Texting
- 2014 Medicare Physician Fee Schedule (“PFS”)
- 501(c)(3)
- Appeal
- Chronic Care Management
- Compounding
- CPR
- Dispenser
- Drug Quality and Security Act (“DQSA”)
- Essential Health Benefits
- HealthCare.gov
- House Bill 3204
- Kindred v. Cherolis
- Long-term care communities
- National Drug Code ("NDC")
- New England Compounding Center ("NECC")
- Outsourcing facility
- Ping v. Beverly Enterprises
- Power of Attorney ("POA")
- Prescriber
- State Health Plan
- Sustainable Growth Rate (“SGR”)
- Affinity Health Plan
- Cadillac tax
- Centers for Disease Control and Prevention
- Community health needs assessment (“CHNA”)
- Condition of Participation ("CoP")
- Denied Claims
- Federation of State Medical Boards (“FSMB”)
- Food and Drug Administratio
- Form 4720
- Grace Period
- Home Medical Equipment Providers
- Individual mandate
- Inpatient Care
- Kentucky Medical Practice Act
- Kynect
- Licensure Requirements
- Long-Term Care Providers ("LTC")
- Medicare Shared Saving Program (MSSP)
- Mobile medical applications ("apps")
- Model Policy for the Appropriate Use of Social Media and Social Networking in Medical Practice (“Model Policy”)
- National Institutes of Health
- Nonprofit hospitals
- Personal Service Entities
- Physician Payments
- Qualified Health Plan ("QHP")
- Social Media
- Spousal coverage
- UPS
- “Superuser”
- "Plan of Correction"
- Arbitration
- Audit
- Daycare centers
- Decertification
- Department of Medicaid Services’ (“DMS”)
- Division of Regulated Child Care
- EHR vendor
- Employer Mandate
- Fair Labor Standards Act (FLSA)
- False Billings
- Health Professional Shortage Areas (“HPSA”)
- Home Health Prospective Payment System
- Hospitalists
- Intermediate Sanctions Agreement
- Kentucky Health Benefit Exchange
- Licensed practical nurses (LPN)
- List of Excluded Individuals and Entities
- LLC v. Sutter
- Low-utilization payment adjustment ("LUPA")
- Meaningful use incentives
- Medicare Administrative Coordinators
- Medicare Benefit Policy Manual
- Network provider agreement
- Nonroutine medical supplies conversion factor (“NRS”)
- Nurse practitioners (NP)
- Office of the National Coordinator for Health Information Technology (“ONC”)
- Part A
- Part B
- Payors
- Physician Recruitment
- Physician shortages
- Provider Self Disclosure Protocol
- Quality reporting
- Registered nurses (RN)
- Residency Programs
- Self-Disclosure Protocol
- Statement of Deficiency ("SOD")
- Upcoding
- Advanced Practice Registered Nurses
- Business Associate Agreements
- Business Associates
- Call Coverage
- Doe v. Guthrie Clinic
- Employer Group Health Plans
- ERISA
- Group Purchasing Organizations ("GPO")
- Health Reform
- House Bill 104
- Kentucky House Bill 217
- Patient Autonomy
- Patient Privacy
- Personal Health Information
- Senate Bill 39
- Senate Finance Committee Report
- State Medicaid Expansion
- Trade Association Group Coverage
- Autism/ASD
- Compliance Programs
- Genetic Information Nondiscrimination Act ("GINA")
- Kentucky House Bill 159
- Kentucky Primary Care Centers (“PCCs”)
- Managed Care Organizations (“MCOs”)
- Abuse and Waste
- Center for Disease Control
- Consumer Operated and Oriented Plan programs (“CO-OPS”)
- Critical Access Hospitals (“CAHs”)
- Essential Health Benefits (“EHBs”)
- Healthcare Information and Management Systems Society (HIMSS)
- Kentucky Cabinet for Health and Family Services
- Kentucky Health Care Co-Op
- Kentucky Health Cooperative (“KYHC”)
- Medicare Audit Improvement Act of 2012
- Occupational Safety and Health Administration (“OSHA”)
- Recovery Audit Contractors (“RAC”)
- Small Business Health Options Program (“SHOP”)
- Sunshine Act
- House Bill 1
- Kentucky “Pill Mill Bill”
- Employee Agreement
- Free Conference Committee Report
- Health Care Fraud and Abuse Control Program
- House Bill 4
- Pain Management Facilities
- Health Insurance
- Healthcare Regulation
- Health Care Law
McBrayer Blogs
Showing 5 posts from November 2014.
HHS OIG RELEASES FISCAL YEAR 2015 WORK PLAN
Recently, the Office of Inspector General of the United States Department of Health and Human Services (“OIG”) released its Fiscal Year 2015 Work Plan summarizing its oversight and enforcement priorities for the 2015 Fiscal Year. Here are some highlights from the Work Plan. More >
Telehealth/Telemedicine: An Opportunity for Physicians and Providers to Add a New Line of Service
The cost effectiveness of providing health care via telemedicine or telehealth promises to be an effective tool to increase coverage and reimbursement of healthcare provided remotely or through telehealth. Towers Watson, a national consulting company, recently published a 2014 study that suggests that telemedicine could save $6 billion annually for the health care industry. "Achieving this savings requires a shift in patient and physician mindsets, health plan willingness to integrate and reimburse such services, and regulatory support in all states," according to Dr. Allan Khoury, a senior consultant at Towers Watson.[1] Recent studies have assigned significant cost savings generated by telehealth use that include cost savings of $537 million per year for emergency departments using telehealth to reduce transfers and spending reductions of 7.7% to 13.3% per person per quarter in the cost of care for chronically ill Medicare beneficiaries using a health buddy via telehealth. [2] As the cost effectiveness of providing services via telehealth and telemedicine is proven, Medicare, most state Medicaid programs and commercial insurers are increasing coverage as well as reimbursement for telehealth services. State law requirements for providing telehealth and coverage differ greatly. Consequently, physicians and health care providers should be aware of the complexity of providing telehealth and its requirements, but should also incorporate telehealth services into their practices as a new way of providing services and a new line of business. More >
The DOJ Increases Scrutiny of Whistleblower False Claims Act Suits
The Criminal Division of the Department of Justice (“DOJ”) recently announced that it will review all complaints filed under the qui tam provisions of the federal False Claims Act (“FCA”) to determine if a parallel criminal investigation is appropriate. This announcement came during a September 17, 2014 speech by the recently-confirmed Assistant Attorney General for the Criminal Division of the DOJ, Leslie Caldwell, at the Taxpayers Against Fraud Education Fund Conference in Washington D.C. This DOJ announcement signals a departure from prior policy, which allowed, but did not require, the Criminal Division to investigate Civil Division claims. In the past, the decision to open a criminal investigation was left to the discretion of each U.S. Attorney’s Office. More >
Kentucky Rural Health Clinics and FQHC’s/Look- A-Likes with Low Rates—Don’t Overlook this Rate Increase!
Approved by CMS and effective July 1, 2014, Kentucky’s Medicaid Program may now pay certain Rural Health Clinics (“RHC”), Federally Qualified Health Care Centers (“FQHC”) and Look-a-Likes a higher rate. The Department of Medicaid Services (“Medicaid”) sought approval to pay RHCs, FQHCs and Look-A-Likes that have a low per visit PPS rate at a rate equal to 125% of the Medicare rate. This means that Kentucky RHCs, FQHCs and Look-A-Likes with low Medicaid rates, just got a raise-- that is if they claim it! While the Medicaid State Health Plan Amendment provides that an “Alternative Payment Methodology” is now available, this really means that clinics with low rates can ask to be paid at a higher rate per visit without qualifying for a change in scope of service. This increase in rate is supposed to be effective on July 1, 2014, but is based upon the Medicare Upper Payment Limit for RHCs as of September 30, 2014 and the rate as we calculate it is approximately $99.70. Essentially, this means that providers with rates below the $99.70 threshold may elect to be paid under the alternative payment methodology. More >
Changes Proposed for Anti-Kickback Statute
It has been said before—healthcare is changing. Most often providers must adapt their practices to comply with governing regulations. Sometimes, governing regulations must be revised to adapt to providers practices. And on occasion, governing regulations must be revised to be consistent with other governing regulations. This is one of those occasions. More >
