Have you decided which MACRA participation option your practice will choose in the 2017 transition year? What you choose now (and how you implement) determines your payment adjustment for Medicare Part B billings in 2019 and beyond. In the second blog post of our MACRA series, we talk about the Merit Based Incentive Payment System (MIPS), and what it means for physicians.
Read MoreThe Final MACRA Rule relaxed the more stringent proposed requirements for 2017, so whether you choose to dip your toe in the water or take the full-on MACRA plunge, now is the time to get MACRA-ready and avoid reimbursement penalties. What does MACRA mean for your practice? That's a question we can help answer.
Read MoreIt just got easier to sue nursing homes. How do you protect your facility and your patients while still maintaining a profit?
This article is a high-level overview of the proposed changes by the Centers for Medicare and Medicaid Services (CMS), as well as the main points you as an Administrator need to know now.
Read MoreLast week, Nixon Law Group attended the Virginia Medical Group Management Association (VMGMA)‘s fall meeting in Williamsburg, and we were lucky enough to sit in on a session by the dynamic and talented Elizabeth Woodcock (of Woodcock & Associates). It was a whirlwind session on the key changes in the 2017 MPFS Proposed Rule, and we wanted to pass along all of the juicy details.
Read MoreBeginning on October 17, 2016, medical practices (and other Covered Entities) who serve Medicare, Medicaid, VA, or TRICARE beneficiaries will be required to implement new practices related to nondiscrimination. The Final Rule, nearly 6 years in the making, is commonly called “Section 1557”--it implements Section 1557 of the Affordable Care Act, the purpose of which is to prevent discrimination based on race, color, national origin, sex, age, or disability
Read MoreAs physician revenues decline, and medical practices are feeling the pressure of the shift to value-based payment, more physicians are choosing to add ancillary services to their practices to boost revenue. Ancillary services are healthcare services provided by a clinician that are in addition to or complementary to basic medical or surgical services. Examples include medication dispensing, radiography, weight-loss services, in-office diagnostic testing, nutrition counseling, alternative treatments, such as acupuncture and massage, physical therapy, immunotherapy, mental health counseling, urgent care, cosmetic (“med spa”) services, and many more.
Read MoreWe often advise our clients that one of the criteria separating a “high risk” breach from a “low risk” breach is whether the breach affects more or fewer than 500 individuals. This is because the HHS Office of Civil Rights (which is the HIPAA enforcement arm of HHS) has historically prioritized investigation of and corrective action following breaches affecting in excess of 500 individuals—OCR’s Regional Offices investigate all reported breaches involving the PHI of 500 or more individuals. However, OCR recently announced that it would be teaming up with its regional office staff to more widely investigate HIPAA breaches affecting fewer than 500 individuals—sending a strong signal to covered entities and business associates that no one is “safe” from repercussions emanating from a HIPAA breach.
Read MoreDespite the risk of experiencing a HIPAA breach exceeding 89%, fewer than half of healthcare organizations have formal incident response plans and procedures. When an actual or suspected breach occurs, it is vital for covered entities and business associates to have a simple, streamlined, and expeditious plan to respond. These breaches can be anything from a lost thumb drive or laptop to a sophisticated cyber-attack, but a good breach response plan will be flexible enough to work in a variety of circumstances. There are standard responses that the Department of Health and Human Services’ (HHS) Office of Civil Rights (the government entity that polices HIPAA compliance) (OCR) expects to see when health data has been compromised. These include protocols for investigation, mitigation, and notification of affected individuals.
Read MoreHealthcare reform and the shift from fee-for-service to value-based reimbursement has brought a host of new complexities to the day-to-day practice of medicine. As a result, more and more physicians are choosing to be employed by a hospital or health system, rather than owning and running their own practice.
While physician employment is not a new concept, the relationship between employed physicians and their employers is shifting as the model for healthcare reimbursement shifts. Employers not only expect their physician employees to meet or exceed RVU (“Relative Value Unit”) production goals, but also to move the needle on certain quality metrics that reflect the overall health of the patient population. This new paradigm creates unique challenges and risks for employed physicians, and is all the more reason for physicians considering employment to pay close attention to what their employment contracts actually require of them.
Read MoreOn May 23, 2016, the Department of Labor passed long-awaited overtime pay rules, modifying the Fair Labor Standards Act (FLSA) for the first time in 12 years. The overtime rules apply to all industries across the country, but will like have a major impact on the healthcare industry, especially independent physician and other clinician employers. The rule significantly increases the amount of money an employee must be paid for that employee to qualify as exempt from the overtime pay rules. This means a much larger pool of employees that now qualify for overtime pay (an additional 4.2 million Americans), and likely significant cost increases for employers. Some healthcare employers will be hit harder than others.
Read MoreIn the latest article in Diagnostic Imaging, NLG Partner Rebecca E. Gwilt offers advice on how medical practices can manage vendor relations. Read the full article here: http://www.diagnosticimaging.com/partnerships/how-be-efficient-vendor-relations
Read MoreThe biggest takeaway from this proposed Rule? Physicians should start planning for this change IMMEDIATELY to best position their practice for financial sustainability. This rule establishes the new Quality Payment Program (QPP) framework, which consists of two new pathways for provider evaluation and payment—the Merit-based Incentive Payment System (MIPS) and participation in Advanced Alternative Payment Models (APMs). The QPP stems from the changes passed as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), passed in April of last year. Participation in one of the QPP pathways will form the new basis for the level of payment for services Medicare Part B providers will receive. CMS will begin collecting data beginning in 2017. They will analyze the data for one year, and then use the data to adjust Medicare payments for eligible providers starting January 1, 2019.
Read MoreThe CMS Center for Medicare and Medicaid Innovation (CMMI) has spent the last 6 years testing out a variety of models for value-based care and payment--the Medicare Shared Savings Program (MSSP) and other ACO models, the Bundled Payments for Care Improvement (BPCI) Initiative, the Comprehensive Care for Joint Replacement Model, and various Medicaid and CHIP initiatives. As the Administration doubles down on its commitment to shift payments away from fee-for-service (FFS), it continues to innovate, building programs to align incentives to person-centered, comprehensive, high quality health care. In that vein, in July of this year, CMS will begin taking applications from practices for participation in a new CMMI program: the CPC+ program.
Read MoreIn the April 4, 2016 edition of Part B News, Rebecca Gwilt talks about integration of behavioral health care into acute and primary care settings.
"For individual physicians, simply instituting a process to administer basic depression screening is an easy first step,” says Gwilt. That might be the kind of depression screening attached to annual wellness visits, which may be quite simple (PBN 3/14/16). Or you can kick it up a notch with something like the PHQ-9 (Patient Health Questionnaire depression eval), the 15-item Geriatric Depression Scale (GDS) or the 20-item Center for Epidemiologic Studies Depression Scale (CES-D)."
Read MoreHealthcare providers in today's environment are dependent upon health information technology like electronic health records, cloud-based billing and practice management solutions, and mobile devices like laptops and iPads to run their practices. The reliability and security of this technology is key to both operations and compliance. However, physicians aren't IT professionals, and practice managers are security specialists. So how do they manage compliance risks without cutting into resources needed to provide patient care? On Tuesday, April 26, 2016, Rebecca E. Gwilt, Esq. and Joan Kassell, MLIS, CPIA will meet with Virginia practitioners to discuss what the data shows are the most common sources of health data breaches and OCR settlements. The data reveals that there are a few simple steps any physician can take to protect their practice and patients and to begin to build a robust compliance program. Topics will include (1) realistic threats to healthcare practices, (2) breaches in the real world and what they tell us, and (3) reducing the likelihood a breach will bury your practice.
Read MoreOn April 10-12, Nixon Law Group's Carrie Nixon and Rebecca Gwilt will be traveling to the Hyatt Regency Chesapeake Bay in Cambridge, MD for the second year in a row to speak at the Mid-Atlantic Telehealth Resource Center's (MATRC) Annual Telehealth Summit. Telehealth Resource Centers (TRCs) are funded by the U.S. Department of Health and Human Service's Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth, which is part of the Office of Rural Health Policy. The 2016 MATRC Telehealth Summit explores how and why telehealth must intersect with both health system transformation and meaningful use if we are to successfully impact all three dimensions of the Institute for Healthcare Improvement's (IHI) "Triple Aim"
Read MoreThere is still time to protect your company or practice. In preparation for potential OCR audits, health care providers and health technology companies should conduct an internal audit of their compliance with State and Federal privacy and security rules, including HIPAA, and begin to address any shortfalls. OCR's increased budget and strategic plans related to HIPAA enforcement should remind the healthcare community of the growing commitment of the Federal Government to strictly enforce its privacy and security protections. Contact your healthcare attorney for advice on how to address your compliance posture.
Read MoreContracts are long and complicated, often missing or obscuring key information a provider needs to make an informed decision about whether to agree to the contract’s terms. In addition, insurance companies are incredibly resistant to modifying their contracts. Contract negotiation employees often say “no” to even minor changes, expecting that the provider will back down. It takes a significant amount of pushing back to gain access to the staff with the power to make changes. Many providers, we know, simply negotiate the fee schedule, and sign the payer contract without a full understanding of its content. We think that is a mistake—these contracts can have legal and financial impacts unrelated to the fee schedule rates, which outlive the contract itself. But, it's not always clear what parts of these gargantuan documents medical practices should be looking for to reduce their risk. In this post, we describe specific types of provisions to read carefully and consider, how easy it will be to change them, and why you may be agreeing to more than the language inside the contract:
Read MoreLearn what kinds of questions you and your medical practice team should be asking when negotiating insurance contracts
Read MoreNixon Law Group is proud to join with the Virginia Chapter of the National Association of Social Workers on March 3-5, 2016, at the Hilton Richmond, to discuss the impact of health reform on social workers and their emerging role in value-based, patient-centered health care.
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