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McBrayer Blogs
Showing 5 posts tagged health care industry.
Governor Signs HB 200 to Address Healthcare Worker Shortage
The COVID-19 public health emergency has impacted the healthcare field in numerous ways. Like the rest of the country, Kentucky has been facing a dire shortage of healthcare workers that was only worsened by the pandemic. The Kentucky Hospital Association’s Workforce Survey Report showed across the commonwealth, at the end of the calendar year (2021), Kentucky hospitals reported 13,423 full-time equivalent (FTE) vacancies across thirteen (13) professional groups, with a statewide hospital workforce vacancy rate of 17.1 percent. Registered nurses (RNs) and licensed practical nurses (LPNs) are the largest profession of direct-care providers and hospitals reported 5,060 RN and 331 LPN vacancies, for a combined vacancy rate of 22.1 percent. More >
OIG, in a Departure, Approves Hospital Provision of Nurse Practitioner Services
Traditionally, the Office of the Inspector General for the U.S. Department of Health and Human Services (“OIG”) would take a hard stance on any arrangements that might involve some form of remuneration from a hospital to a referring physician, but the winds of change may be blowing. In Advisory Opinion 22-20, published in December of 2022, the OIG has given a green light, albeit in a limited context, to an arrangement in which a hospital may have its employee nurse practitioners perform some services traditionally performed by the patients’ primary care physicians. This is a small step in the direction of a more flexible OIG stance on the federal Anti-Kickback Statute (“AKS”), but it doesn’t completely sidestep risks. More >
Pandemic Pivot to Telemedicine Creates New Compliance Issues for Healthcare Providers
The shift to telemedicine in the United States predates the pandemic, but COVID-19 has accelerated its widespread use. In April of 2019, the Centers of Medicare and Medicaid Service (CMS) finalized rules to increase telehealth benefits for Medicare Advantage enrollees, effectively incentivizing health systems with high numbers of private Medicare plan recipients to invest in telehealth services. More >
Malnutrition Diagnosis Codes: The Compliance Danger You’re Not Taking Seriously Enough
It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake. The estimated overpayment as a result of these coding errors is a reported $1 billion. Because the payment error rate was so high at a colossal 31%, Medicare-Severity Diagnosis Related Group ("MS-DRG") applicable entities must take note and prepare for a marked increase in Department of Health and Human Services Office of Inspector General ("OIG") audits for these coding practices. The Centers for Medicare & Medicaid Services ("CMS") also plans to implement review practices for malnutrition coding on a sample of inpatient claims. The increased payer audits will result in severe financial damage for hospitals and other MS-DRG applicable entities if they do not mitigate coding and documentation risks. More >
Compliance Programs for Nursing Facility Providers
Nursing facilities are now required to develop and implement effective compliance and ethics programs under newly-created Section 483.85 of the Affordable Care Act (“ACA”) §6102. These programs must be in effect by November 28, 2017. These regulatory requirements are highly complex, especially the requirement of annual review and revision of the programs. More >
