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RHCs and FQHCs – It’s time to take a second look at Alternate Payment Methodology

September 29, 2015
Posted In Federally Qualified Health Centers (“FQHCs”), Kentucky’s Department for Medicaid Services, Medicaid, Rural Health Centers (“RHCs”)

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 >

A Shot in the Arm of Preventive Health Services

By Anne-Tyler Morgan on September 22, 2015
Posted In Kentucky’s Department for Medicaid Services, Medicaid

The ripple effects of recent changes to the health care industry are still being measured, but Kentucky is already touting what it views as a positive impact of the Commonwealth’s decision to accept the Medicaid expansion under the law. More >

FCC Guidance on Cellphones Puts the Squeeze on Medical Debt Collectors

By Christopher J. Shaughnessy on September 15, 2015

In July, the FCC released an order it touted as strengthening “consumer protections against unwanted calls and texts.” It was a series of rulings based on the Telephone Consumer Protection Act meant to clarify the use of autodialers, procedures for wrong numbers and consent to call, mainly concerning cellphones. Under these new regulations, healthcare providers must get express written consent to be able to contact patients on their mobile phones about medical debt and billing. More >

NIST standards provides an oasis of mobile device security in the EHR desert

September 1, 2015
Posted In Data Breach, Electronic Health Records (“EHR"), Electronic Protected Health Information (ePHI), Health Information Technology for Economic and Clinical Health Act (HITECH Act), Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The healthcare industry has long awaited some certainty in the arena of mobile devices in light of the continued push for electronic health records (“EHR”) and coordinated care. The prevalence, convenience, and speed of such devices is beyond discussion. According to the 2015 HIMSS Mobile Technology Survey, found that 90% of healthcare providers use them in their organizations. Mobile devices provide clinicians with quick access to information at the point of care. However, the use of mobile devices brings a mountain of security risks for covered entities, including the loss or theft of the mobile device and unsecure exchange of health information. When every individual entering a facility has a mobile device, the large number of mobile devices using a facility’s network can overload the system. More >

An Analysis of Urine Toxicology — Considerations for Health Providers

August 18, 2015
Posted In Drug Screening, Health Insurance Portability and Accountability Act of 1996 (HIPAA), Urinalysis

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 >

Providers Wary after First Ruling on 60-Day Rule

By Christopher J. Shaughnessy on August 11, 2015
Posted In Centers for Medicare & Medicaid Services (“CMS”), False Claims Act, Medicaid

The False Claims Act (“FCA”) is already a minefield for healthcare providers, especially when coupled with the Stark Law. Treble damages and fines of up to $11,000 per violation add up quickly under the FCA. The U.S. District Court for the Southern District of New York just made further FCA “reverse false claims” nightmares that much more of a reality in the case of Kane v. Healthfirst. That case is illustrative of how the government will interpret and enforce the Centers for Medicare & Medicaid Services’ (“CMS”) “60-day rule” for retention of overpayments, and the result should make all healthcare providers take notice. More >

CMS Sends a Lifeline on Stark after Tuomey Affirmed: What Health Providers Should Know

By Anne-Tyler Morgan on August 6, 2015
Posted In Centers for Medicare & Medicaid Services (“CMS”), False Claims Act, Medicare, Stark Laws

In July, the Court of Appeals for the Fourth Circuit upheld a record verdict of $237 million against Tuomey Healthcare Systems in the case of U.S. ex rel. Drakeford v. Tuomey Healthcare System, Inc. for violations of the False Claims Act and the Stark Law. Tuomey allegedly violated these laws in over 21,000 claims, submitting bills to Medicare worth $39 million. The False Claims Act allows up to triple damages per claim, as well as a penalty of up to $11,000 per violation. Perhaps in light of such a verdict, the Center for Medicare & Medicaid Services (“CMS”) issued a set of proposed changes and clarifications to the Stark Law that should help healthcare providers to breathe a sigh of relief. More >

CMS Proposes Sweeping Changes for Nursing Home Oversight

July 28, 2015
Posted In Centers for Medicare & Medicaid Services (“CMS”), Department of Health and Human Services (HHS), Medicaid, Medicare

On July 16, 2015, the Center for Medicare and Medicaid Services (“CMS”) published a Proposed Rule with new standards that will have a sweeping effect on the long-term care industry. This new Rule is the first comprehensive review and update to Medicare and Medicaid nursing home standards since 1991. Since the last update, the number of Medicare beneficiaries, excluding Medicare Advantage beneficiaries, residing in nursing homes has tripled to 1.8 million residents and the Medicaid Program has become the primary payer of long term care (64% of residents are on Medicaid).[1] More >

Changes and Challenges for Mental and Behavioral Health Providers

By Lisa English Hinkle on July 23, 2015
Posted In Kentucky’s Department for Medicaid Services, Medicaid, Mental Health Care

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

By Lisa English Hinkle on July 14, 2015
Posted In KASPER, Medicaid, Medicare

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 >

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