Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Medical Spas
- medical billing
- No Surprises Act
- Mandatory vaccination policies
- Workplace health
- Coronavirus Aid, Relief and Economic Security Act
- Code Enforcement
- Department of Labor ("DOL")
- Employment Law
- FFCRA
- CARES Act
- Nursing Home Reform Act
- COVID-19
- SB 150
- Acute Care Beds
- Clinical Support
- Coronavirus
- Emergency Medical Services
- Emergency Preparedness
- Families First Coronavirus Response Act
- Family and Medical Leave Act (“FMLA”)
- KBML
- medication assisted therapy
- 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
- "Two Midnights Rule"
- 340B Program
- EHR Systems
- Hospice
- Kentucky minimum wage
- Minimum wage
- Skilled Nursing Facilities (“SNFs”)
- Uncategorized
- Drug Screening
- Electronic Health Records (“EHR")
- ICD-10
- Primary Care Physicians ("PCPs")
- Urinalysis
- Affordable Insurance Exchanges
- Fraud
- Health Care Fraud
- HIPAA Risk Assessment
- KASPER
- Kentucky’s Department for Medicaid Services
- Mental Health Care
- Office for Civil Rights ("OCR")
- Qui Tam
- Stark Laws
- Accountable Care Organizations (“ACO”)
- Affordable Care Act
- Anti-Kickback Statute
- Centers for Medicare & Medicaid Services (“CMS”)
- Certificate of Need ("CON")
- Compliance
- Data Breach
- Department of Health and Human Services (HHS)
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Federally Qualified Health Centers (“FQHCs”)
- Fee for Service
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Hospitals
- HPSA
- Kentucky Board of Medical Licensure
- Medicaid
- Medical Staff By-Laws
- Medicare
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Part D
- Patient Protection and Affordable Care Act (“ACA”)
- Pharmacists
- Physician Assistants
- Rural Health Centers (“RHCs”)
- Telehealth
- Alternative Payment Models
- Charitable Hospitals
- Health Professional Shortage Area ("HPSA")
- HRSA
- Kentucky Board of Nursing
- 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”)
- Hydrocodone
- Kentucky Pharmacists Association
- Qualified Health Care Centers (“FQHC”)
- Telemedicine
- APRNs
- Chain and Organization System (“PECOS”)
- Jimmo v. Sebelius
- Maintenance Standard
- United States ex. Rel. Kane v. Continuum Health Partners
- Webinar
- Agreed Order
- Chiropractic services
- Clinical Laboratory Improvement Amendments of 1988 (“CLIA”)
- 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
- Ophthalmological services
- Overpayments
- Physician Compare website
- Re-validation
- Texting
- Vitas Innovative Hospice Care
- 2014 Medicare Physician Fee Schedule (“PFS”)
- 501(c)(3)
- All-Payer Claims Database ("APCD")
- Appeal
- Chronic Care Management
- Compliance Officer
- Compounding
- CPR
- Dispenser
- Drug Quality and Security Act (“DQSA”)
- Essential Health Benefits
- HealthCare.gov
- House Bill 3204
- ICD-9
- 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”)
- "Plan of Correction"
- Affinity Health Plan
- Arbitration
- Cadillac tax
- Centers for Disease Control and Prevention
- Community health needs assessment (“CHNA”)
- Condition of Participation ("CoP")
- Daycare centers
- Denied Claims
- Department of Medicaid Services’ (“DMS”)
- Division of Regulated Child Care
- Employer Mandate
- Federation of State Medical Boards (“FSMB”)
- Food and Drug Administratio
- Form 4720
- Grace Period
- Health Professional Shortage Areas (“HPSA”)
- Home Health Prospective Payment System
- Home Medical Equipment Providers
- Hospitalists
- Individual mandate
- Inpatient Care
- Intermediate Sanctions Agreement
- Kentucky Health Benefit Exchange
- Kentucky Medical Practice Act
- Kynect
- Licensure Requirements
- LLC v. Sutter
- Long-Term Care Providers ("LTC")
- Low-utilization payment adjustment ("LUPA")
- 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
- Network provider agreement
- Nonprofit hospitals
- Nonroutine medical supplies conversion factor (“NRS”)
- Payors
- Personal Service Entities
- Physician Payments
- Physician Recruitment
- Physician shortages
- Qualified Health Plan ("QHP")
- Quality reporting
- Residency Programs
- Social Media
- Spousal coverage
- Statement of Deficiency ("SOD")
- Upcoding
- UPS
- “Superuser”
- Advanced Practice Registered Nurses
- Audit
- Business Associate Agreements
- Business Associates
- Call Coverage
- Decertification
- Doe v. Guthrie Clinic
- EHR vendor
- Employer Group Health Plans
- ERISA
- Fair Labor Standards Act (FLSA)
- False Billings
- Group Purchasing Organizations ("GPO")
- Health Reform
- House Bill 104
- Kentucky House Bill 217
- Licensed practical nurses (LPN)
- List of Excluded Individuals and Entities
- Meaningful use incentives
- Medicare Administrative Coordinators
- Medicare Benefit Policy Manual
- Nurse practitioners (NP)
- Office of the National Coordinator for Health Information Technology (“ONC”)
- Part A
- Part B
- Patient Autonomy
- Patient Privacy
- Personal Health Information
- Provider Self Disclosure Protocol
- Registered nurses (RN)
- Self-Disclosure Protocol
- Senate Bill 39
- Senate Finance Committee Report
- State Medicaid Expansion
- Trade Association Group Coverage
- Autism/ASD
- Compliance Programs
- Critical Access Hospitals (“CAHs”)
- Essential Health Benefits (“EHBs”)
- Genetic Information Nondiscrimination Act ("GINA")
- Kentucky House Bill 159
- Kentucky Primary Care Centers (“PCCs”)
- Managed Care Organizations (“MCOs”)
- Medicare Audit Improvement Act of 2012
- Recovery Audit Contractors (“RAC”)
- Small Business Health Options Program (“SHOP”)
- Sunshine Act
- Abuse and Waste
- Center for Disease Control
- Consumer Operated and Oriented Plan programs (“CO-OPS”)
- Healthcare Information and Management Systems Society (HIMSS)
- Kentucky Cabinet for Health and Family Services
- Kentucky Health Care Co-Op
- Kentucky Health Cooperative (“KYHC”)
- Kentucky “Pill Mill Bill”
- Occupational Safety and Health Administration (“OSHA”)
- Employee Agreement
- Free Conference Committee Report
- Health Care Fraud and Abuse Control Program
- House Bill 1
- House Bill 4
- Pain Management Facilities
- Health Care Law
- Health Insurance
- Healthcare Regulation
McBrayer Blogs
Showing 5 posts from May 2014.
FINALLY SOME RELIEF TO PROVIDERS—CMS ORDERED TO NO LONGER APPLY A COMMON RULE OF THUMB WHEN AUDITING
Health care providers are always at risk of a payor audit, and contracted auditors seem to be more aggressive now than ever. While MIC, MAC, and ZPIC audits as well as pre-payment reviews of late have become more efficient with the use of rules of thumb to flag specific codes commonly misapplied, the U.S. District Court of Vermont’s ruling in Jimmo v. Sebelius puts the brakes on such fishing expeditions. In holding that, in the case of skilled nursing services, there is no “improvement standard” and claims should be reviewed on a case by case basis, the court has limited CMS in its ability to apply arbitrary standards in denying reimbursement for covered services. More >
Electronic Data Breach Leads to Largest HIPAA Settlement to Date
Recently, the Office of Civil Rights (“OCR”) of the Department of Health and Human Services entered into a $4.8 million dollar settlement with two New York-based health care organizations after a data breach involving electronic protected health information occurred. The agreement is the largest HIPAA settlement thus far. More >
Time to “Face” The Risks
In 2011, the U.S. Centers for Medicare and Medicaid Services (“CMS”), as part of the reform instituted by the Affordable Care Act, required that home health agencies and hospice patients receive a face-to-face visit (at specified time periods) by a physician or nurse practitioner to ensure that they continue to meet Medicare and Medicaid eligibility criteria. More >
All Eyes on Hospice Care
In 2013, the Department of Justice (“DOJ”) and Office of Inspector General (“OIG”) charged the nation’s largest for-profit hospice chain, Vitas Innovative Hospice Care (“Vitas”), with false Medicare billings, inappropriately admitting patients with “aggressive marketing tactics,” and misleading patients and families about Medicare hospice benefits. This suit is just one of many recently filed against hospice providers, indicating that they are being watched keenly by enforcement authorities and government agencies. More >
Important Reminder for Association Group Health Plans
In Kentucky, most trade association-sponsored health plans renew on July 1, 2014. Now is an excellent time for trade association executives to review association and Health Plan materials to ensure compliance with applicable Federal and State requirements prior to renewal. More >
