Posts in Medical Practice
No Significant Fraud: CMS findings relieve concerns over Medicare Telehealth during COVID
No Significant Fraud: CMS findings relieve concerns over Medicare Telehealth during COVID

Discover what the OIG found when investigating telehealth billing fraud, what they recommend regarding future CMS oversight, and four takeaways for businesses billing Medicare telehealth services.

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Digital Health, Fraud and Abuse, Medical Practice, Medicare, OIG, Physician Fee Schedule, Regulations, Reimbursement, Remote Monitoring, Telehealth, Virtual Care, Virtual Care ManagementFaisal Khantelehealth, virtual care managemet, remote monitoring, oig, cms, fraud, Medicare claims, billing, risk management, audits, investigations, regulation
The 2023 Medicare Physician Fee Schedule Proposed Rule: Everything You Need to Know Now [video]
The 2023 Medicare Physician Fee Schedule Proposed Rule: Everything You Need to Know Now [video]

Whether you are building a business aimed at facilitating RTM for healthcare providers or growing a direct-to-consumer RTM practice, you know that reimbursement requirements significantly impact several of your most important business decisions.

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Behavioral Health, Digital Health, Medical Practice, Medicare, Physician Fee Schedule, Physicians, Provider, Reimbursement, Remote Monitoring, Remote Patient Monitoring, Regulations, Telehealth, Telemedicine, Virtual Care Management, WebinarNixon Gwilt Law2023 MPFS, reimbursement, behavioral health, chronic pain management, RTM, telehealth
Digital Health Companies: How to choose a business model to bring your consumer-centric care to the market
Digital Health Companies: How to choose a business model to bring your consumer-centric care to the market
Digital Health, Life Sciences, Medical Practice, MSO, Physicians, Regulations, Reimbursement, Remote Monitoring, Remote Patient Monitoring, Telehealth, Telemedicine, Virtual Care ManagementRebecca GwiltDigital Health, regulation, Virtual care, business, market, Telehealth, Virtual care management, virtual care compliance, direct to consumer, friendly PC, friendly physician MSO, provider, healthcare provider, telehealth network, MSO, pharmacy, telepharmacy, mobile medical applications
Tommy Miller with Rocket Factory: 5 Tips from the Negotiation Table
Tommy Miller with Rocket Factory: 5 Tips from the Negotiation Table

With “Episode 3: 5 Tips from the Negotiation Table,” Tommy and I will dive into the following topics that should be relevant for every investor, founder, and CEO: Have a solid but flexible strategy/commercialization plan; Know and understand your competitive landscape, and how you will fit into/disrupt it.; Begin your company with the end in mind – preparing for exit; Be well-prepared in highly regulated industries (regulatory paths, documentation, marketing, information systems); What are your use cases and who is paying?

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Healthcare Law Firm, Medical Practice, Vendor RelationsTommy Millerstartup, Tommy Miller
How to Get Paid for Patient "e-Visits" under the 2020 Medicare Physician Fee Schedule
How to Get Paid for Patient "e-Visits" under the 2020 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) released the Final Medicare Physician Fee Schedule for CY 2020 (the “2020 MPFS”) on November 1, 2019. The 2020 MPFS finalizes six new CPT codes for e-Visits, providing new opportunities for physician practices to be reimbursed for conducting digital health assessments and evaluations for their patients and for remote patient monitoring companies to add these capabilities to their platforms.

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CMS Programs, Healthcare Law Firm, Medical Practice, Medicare, Physician Fee Schedule, Physicians, Regulations, Remote Patient Monitoring, ReimbursementKaitlyn O'ConnorRemote Patient Monitoring, Remote Monitoring, RPM, Digital Health, virtual care, 2020 MPFS, 2020 Medicare Physician Fee Schedule, Coronavirus
Proposed 2020 Medicare Physician Fee Schedule offers new reimbursement for Remote Patient Monitoring
Proposed 2020 Medicare Physician Fee Schedule offers new reimbursement for Remote Patient Monitoring

On July 29, 2019, the Center for Medicare and Medicaid Services (“CMS”) released its proposed rule for the 2020 Medicare Physician Fee Schedule (the “2020 MPFS”).

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Health IT, Medical Practice, Physician Fee Schedule, Medicare, Physicians, Remote Patient MonitoringCarrie NixonRemote Monitoring, Remote Patient Monitoring, Medicare, 2020 Medicare Physician Fee Schedule, physician practice, Physicians, Reimbursement, Coronavirus
New CMS Innovation Models: Primary Care First and Direct Contracting
New CMS Innovation Models: Primary Care First and Direct Contracting

In April, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced a new set of payment models meant to allow primary care providers deliver better care at a lower cost to their patients by removing unneccessary administrative and adjust payouts from procedures to outcomes.

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CMS Programs, Healthcare Reform, Medicare, Physicians, Medical Practice, Regulations, ReimbursementCarrie NixonHealthcare innovation, CMS, Medicare, medicaid, regulations
Reimbursement and Practical Considerations for House Call Practices
Reimbursement and Practical Considerations for House Call Practices

Are you thinking about starting a new house call practice? There will be things you need to prepare for (and budget for), so Nixon Law Group compiled this information. Note that major concerns include whether commercial clients can reimburse, what kinds of safety needs there are, and Medicare requirements for a “practice location.” Read more below and feel free to contact us with questions!

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Assisted Living, Medical Practice, PhysiciansRebecca Gwiltcpt codes, house call practice, medical practice, Healthcare compliance
Considerations for Clinician Contracting – An Employer Perspective
Considerations for Clinician Contracting – An Employer Perspective

Having written a series of posts over the years addressing employment contracting from the physician perspective, one of our readers reached out to let us know that Nixon Law Group should, likewise, address physician/clinician employment contracting from the perspective of the healthcare employer.  Considerations for Clinician Contracting – An Employer Perspective…

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Employment, Medical Practice, Physician Fee Schedule, PhysiciansCait Riccobonoemployment contract, physician contracts, contract negotiation, healthcare business, Healthcare corporate and transactional
Proposed Healthcare Legislation in the 2019 Virginia General Assembly
Proposed Healthcare Legislation in the 2019 Virginia General Assembly

On January 9, the 2019 General Assembly Session will convene, and there are several bills that are set to be introduced that may have an impact on Virginia healthcare providers. We will update this post with additional legislation as session progresses.

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Healthcare Reform, Legislation, Medical Practice, PhysiciansRebecca GwiltVirginia, healthcare information, legislation, healthcare attorney, Nurse Practitioner, physician practice, Healthcare corporate and transactional
How to Get Paid for Remote Interprofessional Consultation between Physicians
How to Get Paid for Remote Interprofessional Consultation between Physicians

Beginning January 1, 2019, physicians and other Qualified Healthcare Providers (“QHCPs”) eligible to independently bill for E/M services can obtain standalone reimbursement for Interprofessional Internet Consultations using CPT Codes 99446-99449, 99451, and 99452.

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Medical Practice, Medicare, Physician Fee Schedule, Physicians, Reimbursement, Remote Patient Monitoring, TelehealthKaitlyn O'ConnorInterprofessional internet consultation, MPFS, 2019 Medicare Physician Fee Schedule, CPT 99446, CPT 99447, CPT 99448, CPT 99449, CPT 99451, CPT 99452, CPT, Remote Patient Monitoring, Remote Monitoring, Healthcare innovation, Coronavirus
CMS introduces CPT Codes 99453, 99454, and 99457 to reimburse for Chronic Care Remote Patient Monitoring
CMS introduces CPT Codes 99453, 99454, and 99457 to reimburse for Chronic Care Remote Patient Monitoring

The final 2019 Medicare Physician Fee Schedule (the “Rule”), released on November 1st, creates three new codes in the category of Chronic Care Remote Physiologic Monitoring (“CCRPM”) for (1) initial set-up and patient education, (2) initial device supply, and (3) monitoring data and interacting with patients or caregivers.

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Medical Practice, Medicare, Physician Fee Schedule, Physicians, Regulations, Reimbursement, Remote Patient MonitoringKaitlyn O'ConnorRemote Monitoring, Remote Patient Monitoring, chronic condition, Chronic Care Management, medicare, 2019 Medicare Physician Fee Schedule, Healthcare innovation, Coronavirus
HCPCS Code G2010 reimburses for Remote Evaluation of Patient-Submitted Images and Video
HCPCS Code G2010 reimburses for Remote Evaluation of Patient-Submitted Images and Video

The final 2019 Medicare Physician Fee Schedule, released by CMS on November 1, 2018, includes a new code that physicians may use to bill for remote evaluation of images to determine whether or not an in-person office visit is necessary. Learn more about HCPCS Code G2010 and how it can be used in medical practices.

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Medical Practice, Medicare, Physician Fee Schedule, Physicians, Regulations, Reimbursement, Remote Patient Monitoring, TelehealthCarrie NixonRemote Monitoring, Remote Patient Monitoring, Reimbursement, HCPCS G2010, 2019 Medicare Physician Fee Schedule, Coronavirus
How to get Reimbursed for Virtual Check-ins under HCPCS Code G2012
How to get Reimbursed for Virtual Check-ins under HCPCS Code G2012

In its Final Rule for the 2019 Medicare Physician Fee Schedule released on Friday, CMS introduced a new code, HCPCS G2012, allowing physicians and other qualified healthcare professionals (“QHCPs”) to be reimbursed for “virtual check-ins” with patients who aren’t sure whether or not their symptoms warrant an in-office visit. Learn more about virtual check-ins and how they can be used by practices.

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Medical Practice, Medicare, Physicians, Regulations, Reimbursement, Remote Patient Monitoring, Physician Fee ScheduleRebecca GwiltRemote Patient Monitoring, Remote Monitoring, virtual check-in, 2019 Medicare Physician Fee Schedule, QHCP, Qualified Health Care Professional, HCPCS G2012, Healthcare innovation, Coronavirus
When Do I Need a Healthcare Attorney? Responding to an Investigation by the Virginia Department of Health Professions
When Do I Need a Healthcare Attorney? Responding to an Investigation by the Virginia Department of Health Professions

“Do I really need a healthcare attorney? The Board is simply asking me to answer some questions and provide some documentation. Of course, a Board complaint is a big deal, but this part seems harmless/easy enough. I will just respond and tell them what happened, right?” The reality is that an effective response is not as straightforward as it may seem. Hiring a healthcare attorney to assist in the preparation of your response to a complaint investigation can improve your chances of resolving the complaint at the investigation stage, incidentally saving you money in the long run.

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Medical Practice, PhysiciansCait Riccobonoclinician, licensure, Board, Department of Health Professions, investigation, discipline
How Can My Startup Get the IRS and State Department of Taxation to Help Pay for My R&D?
How Can My Startup Get the IRS and State Department of Taxation to Help Pay for My R&D?

Act Fast – State deadline is July 1st!

Tax credits are a great way to increase cash flow for your business, and it may come as a surprise to many that millions of dollars go unclaimed each year.

If you’re a high growth start-up or early stage business engaging in research and development (R&D), you’re likely leaving State and Federal money on the table. Continue reading to see if you qualify for tax credits to help you propel your business. 

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Medical Practice, RegulationsRebecca Gwilttaxes, startup, federal r&d credit, virginia r&d credit, Healthcare innovationComment
Can Nurse Practitioners Run Their Own Practices in Virginia?
Can Nurse Practitioners Run Their Own Practices in Virginia?

In April 2018, Governor Ralph Northam signed House Bill 793, which will allow Virginia nurse practitioners (NPs) with the equivalent of five years of full-time practice with a collaborating physician to be certified to practice independently.  What does this mean for NPs in Virginia? Practically speaking, if a nurse practitioner meets the qualifications and makes the appropriate filings with the Board of Nursing, he or she can open up an independent practice to provide care in their community. This change aligns Virginia law with more than twenty other states across the country in adopting full practice authority and is expected to expand access to affordable primary care to thousands of Virginians. 

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Medical Practice, RegulationsKatherine Bain, Esq.Nurse Practitioner, full practice authority, independent practice, nurses, collaborating physician, patient care team
To Text or Not to Text: Clarification for Healthcare Providers on Texting Patient Information
To Text or Not to Text: Clarification for Healthcare Providers on Texting Patient Information

On December 28, 2017, the Centers for Medicare & Medicaid Services (CMS) released a Memorandum (the “Memo”), effective immediately, that represents a clear change to previous guidance on the use of SMS Text Messaging or “texting” by healthcare providers to transmit patient information to other providers that are part of a patient’s care team.

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Health IT, HIPAA, Medical Practice, RegulationsKaitlyn O'ConnorPatient Health Information, Patient Information, Texting patient information, Texting, CMS
How to get paid for Remote Patient Monitoring with CPT Code 99091
How to get paid for Remote Patient Monitoring with CPT Code 99091

Two Final Rules issued by CMS in November 2017 opened up entirely new avenues for reimbursement of Remote Patient Monitoring services in 2018, creating the potential for better patient outcomes and a boost to a medical practice's bottom line.

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Medicare, Medical Practice, Physicians, Reporting, TelehealthCarrie NixonCPT Code 99091, Remote Patient Monitoring, Telehealth, Patient Generated Health Data, Reimbursement, Clinical Practice Improvement Activities, Advancing Care Information, Quality Payment Program, MACRA, MIPS, 2018 Medicare Physician Fee Schedule, Coronavirus