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.
Read MoreTwo 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.
Read MoreLast week, CMS issued a Proposed Rule suggesting changes for Year 2 of the Quality Payment Program ("QPP"), established under the Medicare Access and CHIP Reauthorization Act of 2015. The changes are aimed at reducing administrative and financial burdens of the QPP on physician practices, particularly small independent practices and practices serving rural communities. Per CMS, the Proposed Rule "continues the slow ramp-up of the Quality Payment Program by establishing special policies for Program Year 2 aimed at encouraging successful participation in the program while reducing burden, reducing the number of clinicians required to participate, and preparing clinicians for the CY 2019 performance period."
Read MoreCaitlin Riccobono, Esq., Counsel at Nixon Law Group, develops these routine “Partners Pointers” for the Virginia-based healthcare organization Partners in Healthcare.
Topic: Business Associates of Business Associates
I was asked to address two main questions regarding a Business Associate that is a subcontractor of another Business Associate (we will call this a “Sub-BA”). First, to what extent is a Sub-BA permitted access to PHI? Second, what are the Sub-BA’s obligations with respect to safeguarding PHI?
Read MoreBefore signing an employment contract, it is crucial to understand the details of your compensation package. Often, things are not as straightforward as they may appear, and small details may make a big difference to your take-home bottom line and your lifestyle. Before you sign on the dotted line, consider both the cash and non-cash components and evaluate what is most important to you.
Read MoreFive new safe harbors have been added to the Anti-Kickback Statute (AKS) in the final rule, issued on December 17, 2016 by the Health and Human Services Office of the Inspector General (OIG). In addition, existing safe harbors have been revised to grant further protections to providers from criminal prosecution and civil damages. What these changes mean for providers: The trend in healthcare is to move from volume-based care to value-based care.
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 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 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 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 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
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