Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Part 2
- Data Privacy
- Department of Health and Human Services' Office of Civil Rights
- Medical Malpractice
- Medical Cannabis
- Workplace health
- Workplace Violence
- Assisted Living Facilities
- EMTALA
- FDA
- Reproductive Rights
- Roe v. Wade
- SCOTUS
- COVID-19
- Prescription Drugs
- Telemedicine
- Medical Spas
- Code Enforcement
- Corporate
- Employee Contracts
- Non-Compete Agreement
- United States Department of Justice ("DOJ")
- Compliance
- HIPAA
- Kentucky Board of Nursing
- Managed Care Organizations (“MCOs”)
- Anti-Kickback Statute
- False Claims Act
- KASPER
- Kentucky’s Department for Medicaid Services
- Medicaid
- Mental Health Care
- Office for Civil Rights ("OCR")
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Primary Care Physicians ("PCPs")
- Qui Tam
- Stark Laws
- Accountable Care Organizations (“ACO”)
- Affordable Care Act
- APRNs
- Centers for Medicare & Medicaid Services (“CMS”)
- Charitable Hospitals
- Data Breach
- Electronic Protected Health Information (ePHI)
- Federally Qualified Health Centers (“FQHCs”)
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Health Professional Shortage Area ("HPSA")
- Hospitals
- HPSA
- HRSA
- Kentucky Board of Medical Licensure
- Medicare
- Mid-Level Practitioners
- Patient Protection and Affordable Care Act (“ACA”)
- Pharmacists
- Physician Assistants
- Rural Health Centers (“RHCs”)
- Rural Health Clinic
- Telehealth
- Business Associate Agreements
- Fraud
- Part D
- Appeal
- Compliance Programs
- Electronic Health Records (“EHR")
- ERISA
- Hospice
- Overpayments
- Advanced Practice Registered Nurses
- Business Associates
- Denied Claims
- Division of Regulated Child Care
- Employee Agreement
- Fair Labor Standards Act (FLSA)
- Licensed practical nurses (LPN)
- Licensure Requirements
- Nurse practitioners (NP)
- Part A
- Part B
- Personal Health Information
- Personal Service Entities
- Physician Payments
- Qualified Health Plan ("QHP")
- Registered nurses (RN)
- Abuse and Waste
- Occupational Safety and Health Administration (“OSHA”)
- Patient Autonomy
- Department of Health and Human Services (HHS)
- Health Insurance
- Healthcare Regulation
- Health Care Law
McBrayer Blogs
Showing 23 posts from 2015.
Primary Care Providers – Are you feeling the pinch?
It was nice while it lasted – due to a provision of the Patient Protection and Affordable Care Act (“ACA”), services furnished by certain primary care providers (“PCPs”) were subject to an enhanced payment rate for Calendar Years 2013 and 2014. These PCPs had to have (a) been Board certified in the specialty designation of family medicine, general internal medicine or pediatric medicine or have a subspecialty designation recognized by specific boards or associations, or (b) furnished more than 60% of claims in specific evaluation and management or vaccine administration services under certain codes to have been eligible for these enhanced payments.[1] The payments were raised to the level of the Medicare Part B fee schedule rate (unless the actual billed charge for the service was lower), and providers had until April 1, 2013 to self-attest to being eligible.[2] The increase applied to both fee-for-service and managed care Medicaid plans. More >
RHCs and FQHCs – It’s time to take a second look at Alternate Payment Methodology
In July of 2014, Kentucky Medicaid established an Alternate Payment Methodology (“APM”) for all Federally-Qualified Health Centers (“FQHCs”) and Rural Health Clinics (“RHCs”) as an alternative to the all-inclusive encounter rate per patient under the standard prospective payment system (“PPS”) of 42 U.S.C. 1369a(aa). The APM allows for qualified centers to be reimbursed at a rate of 125% of the 2014 Medicare Upper Payment Limit for RHCs in place of the PPS system ($99.75 per covered visit). There are more advantages to APM than meet the eye, however, and qualified centers currently using PPS method should at the very least reevaluate APM, as proposed changes will make APM even more attractive and potentially risk-free. More >
An Analysis of Urine Toxicology — Considerations for Health Providers
Urine toxicology, also referred to as urine drug screening, is an important procedure that health providers use for several reasons: to monitor patients’ medication compliance, detect drug abuse, or identify the presence of disease. There are numerous implications that accompany a urine toxicology examination though, and health providers are sometimes left wondering if they should hand over the cup to patients. More >
Changes and Challenges for Mental and Behavioral Health Providers
As Kentucky’s Senate Bill 192 highlights, coverage and treatment of substance abuse problems is dramatically changing as the current penal model is slowly being replaced with a treatment model. Even terminology for what has been called "drug addiction" is now referred to as a "substance disorder" problem. Behavioral health has become the new catchall name for both mental health and substance disorders. As substance disorders become medical problems rather than drug abuse problems, the Federal Mental Health Parity Act and the Affordable Care Act now mandate that substance disorders and mental health problems, which often go hand in hand, must be covered by health insurance just as medical problems are covered. As of January 1, 2015, these illnesses must also covered by Medicare and Medicaid. Paving the road for coverage, however, has not been easy as a wealth of new federal and state government regulations are creating a complicated framework with a host of changes for behavioral health providers. While Kentucky struggles to provide and pay for services for the 150,000+ new Medicaid beneficiaries, these new laws and regulations significantly affect not just behavioral health providers, but also employers as the struggle to treat individuals who suffer from these maladies is addressed. More >
Think Twice about DEA Voluntary Surrender
It can be an intimidating experience to be sure... A DEA agent or Diversion Investigator, on an unscheduled visit to your office, confronts you with a KASPER, a KBML complaint or some other state regulatory action and alleges violations of the Controlled Substances Act. The DEA Agent then asks you to sign DEA Form 104. This form, which is titled “Voluntary Surrender of Controlled Substances Privileges,” is placed in front of you while the agent explains why you should sign it immediately, rather than face potential action to revoke your DEA and other adverse consequences. The DEA Agent tells you that you are already in deep, deep trouble (of a vague and unspecified nature), and that the simple act of signing this form can make your troubles go away and prevent federal action. Also, he tells you that all you have to do to get the number back is to reapply! Hold on...this is not the full story! This scenario is becoming a harsh reality and common situation for physicians, pharmacists, nurse practitioners, and PAs. More >
Plan for the Worst, Hope for the Best: Why You Must Have a HIPAA Risk Assessment
“The single biggest and most common compliance weakness is the lack of a timely and thorough risk analysis.” More >
Structuring Healthcare Provider Agreements for Compliance
On June 23rd, the Healthcare Law Blog discussed the Fraud Alert recently issued by the Office of Inspector General of the United States Department of Health and Human Services regarding physician compensation arrangements which telegraphed the Office of Inspector General’s intention to increase scrutiny of financial arrangements between physicians and providers to whom physicians make referrals. In today’s post, we examine the steps physicians and other healthcare providers should take to ensure that any financial relationships are in compliance with federal statutes and regulations. More >
The False Claims Act - the Basics Every Provider Should Know, Part Two
On Tuesday, we discussed the history and basic elements of a violation of the False Claims Act. Today’s post will explore the penalties and enforcement of the Act. More >
The False Claims Act – the Basics Every Provider Should Know, Part One
The federal False Claims Act (“FCA”)[1] casts an incredibly long shadow, covering every transaction between the federal government and a private party seeking payment from it. Enacted at the height of the Civil War in 1863, the law was designed to keep military suppliers honest in their dealings with a government already strapped from fighting a war. Since then, the FCA has served as an almost nuclear deterrent to those who would attempt to defraud the government when requesting payment for services. In 2014, the Department of Justice managed to recover $5.69 billion under the law. False claims in federal healthcare programs accounted for $2.3 billion of that figure, which makes the FCA, as well as its interaction with other laws such as the Affordable Care Act, fraught with difficulty for unwary healthcare providers. More >
Issues Concerning Substance Abuse Patient Confidentiality Laws
It was with the best of intentions that Congress passed the Federal Confidentiality of Alcohol and Drug Abuse Patient Records Law over forty years ago. The patient privacy regulations (“Part 2”) spawned by this law reflected a sensitivity to the stigma that can accompany substance abuse, preventing highly vulnerable patients in need from seeking appropriate treatment.[1] In the interim, however, the field of behavioral health care has experienced seismic shifts in coordinated patient care while the regulations concerning these patient records have failed to adapt to changing standards such as electronic health records or health information exchanges. Due to this inflexibility, providers and patients are now facing a host of impediments in the provision of behavioral healthcare. More >
