Articles Posted in Healthcare Information

aba-therapist-play-therapy-young-boy-e1690574727628Our healthcare and business law firm works with many behavioral health providers in establishing and operating their ABA associated businesses.  We have a particular focus on such companies and will be producing a series of helpful articles to assist providers in navigating various operational and business hurdles to ensure they are able to effectively treat their patients.

If you have questions regarding this blog post or would like to speak with counsel regarding opening your medical spa practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Introduction

Payment and claims audits for ABA providers are becoming increasingly more common given the rising number of patients being cared for with autism and related disorders. For most ABA providers, an audit is no longer a probability but a certainty. Continue reading ›

1651676570_Transworld-May-Blog-Header950x460-e1686600049528As a healthcare and business law firm, we have many clients who participate in or wish to participate in pain management clinics.  A previous blog post of ours provided an overview of pain management clinics.  When it comes to selling a pain management clinic, there are certain questions to consider. This post provides a look into 3 questions to ask when selling your pain management and the answer to those questions.  Please note, there are numerous considerations when selling a medical practice that apply to pain management clinics as well, but this post focuses only on pain management considerations.  If you have questions regarding this blog post or would like to speak with counsel regarding selling your practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

In 2013, Georgia legislatures enacted House Bill 178 (“HB 178”) known as the Georgia Pain Management Clinic Act.  The act requires pain management clinics to obtain a license from the Georgia Medical Board and limits who can own pain management clinics.  These requirements add questions when it comes to selling a pain management clinic. Continue reading ›

med-mal-featured-1-e1685565240921Our healthcare and business law firm works with many physician and other health care providers who own their own medical practice.  The Georgia Medical Board and Georgia Legislature, as well as many other state medical boards and legislatures, have noted concern with consumer confusion with the numerous titles held by non-physician health care practitioners.  For instance, “In a survey done a few years ago by the AMA, 39% of patients thought a Doctor of Nursing Practice was a physician and 11% weren’t sure. Half were either completely wrong or confused by a title. More than half (61%) thought a Doctor of Medical Science was a physician, which is completely incorrect.” M. Blackman, J. Commins, “Industry Stakeholders Divided on GA ‘Truth and Transparency’ Act,” Health Leaders Media (May 25, 2023).  This and other information caused the Georgia Legislature to act in an attempt to protect consumers from misunderstandings.  That change resulted in Senate Bill 197, known as the Health Care Practitioners Truth and Transparency Act, which was signed into law in May of 2023.  The bill made changes to the “Consumer Protection and Awareness Act,” O.C.G.A. Section 43-1-33.  Importantly, the legislatures concern here seemed to arise less from intentional or malicious misstatements from health care practitioners, and more from consumer misinformation/misunderstanding caused honestly by the numerous titles and credentials that may be held by practitioners that consumers do not understand.

This post identifies three key provisions with the Health Care Practitioners Truth and Transparency Act.  If you have questions regarding this blog post or would like to speak with counsel regarding laws that may impact you or your medical spa practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

  1. Expansion of Definition of and Rules for “Advertisements”

iStock-1056799938-e1684354865672Both concierge medicine and direct primary care practices have become popular alternatives to the traditional insurance medical practice model.  Direct Primary Care (“DPC”) practices generally cut insurance companies out from the provider-patient relationship.  Medicare offers unique considerations because participating and non-participating providers maintain certain responsibilities regarding Medicare beneficiaries, and many providers are hesitant to “opt out” of Medicare.  With this post, we intend only to highlight a few points to consider before accepting private pay from Medicare beneficiaries outside of copays.  If you have questions regarding this blog post or starting a concierge practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

 

Point 1- A Medicare-participating provider violates Medicare requirements by accepting private payment from a Medicare beneficiary for services that in whole or part constitute “covered services” as defined by Medicare.

Point 2- The federal Department of Health and Human Services (“HHS”) has established that requiring payment for non-covered services does not violate Medicare requirements. In fact, the HHS Office of Inspector General (“OIG”) states on its website: “It is legal to charge patients for services that are not covered by Medicare.”

Point 3- A complicating aspect of the seemingly simple rule is that whether a service is a “covered service” is determined solely by CMS, not by you.  Therefore, including language in a patient agreement such as “this fee does not cover any covered services”, though perhaps adequate to express an intention, does not prevent a practice/provider from being found to have violated Medicare rules. Continue reading ›

HIPAA-Breaches-Healthcare-Students-e1615468812558On April 11, 2023, U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced its plan to allow the Notifications of Enforcement Discretion issued under HIPAA and the HITECH Act during the COVID-19 Public Health Emergency (PHE) to expire on May 11, 2023.

Early on in the COVID-19 pandemic, the use of telehealth appointments increased dramatically in an effort to prevent the spread of COVID-19 as millions of doctors’ visits and health care examinations were often postponed or even canceled. OCR quickly recognized the critical need to assist the healthcare sector and the public in responding to this unprecedented crisis and in 2020 and 2021, published four Notifications of Enforcement Discretion in the Federal Register regarding how the Privacy, Security, Breach Notification, and Enforcement Rules under HIPAA would be applied to certain violations during the PHE. Continue reading ›

nurses-and-docs-e1681928313827Our healthcare and business law firm often assists physicians and other providers in obtaining and maintaining licensure.  Sometimes, physicians desire assistance to ensure a smooth process without having any occurrences to disclose.  The majority of the time, however, when we are hired to assist in licensure matters, the physician has a past or ongoing event that they need assistance with.  We usually begin by evaluating whether the occurrence must be, should be, or need not be disclosed.  One important question that is always present and concerning to many is the mental health question, which is also the first question on the Applicant Questionnaire section of the license application in Georgia.  There have been different iterations of this question over the years, and earlier this year, the Medical Board modified the questions once again.  This post explains the progression of this question in Georgia. If you need assistance applying for or maintaining licensure or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

The mental health question on applications for licensure can be alarming to many physicians. Continue reading ›

Prepayment-Review-Shift-Blog-07-22-2016-e1681242443952Our healthcare and business law firm often assists medical practices in responding to medical record and coding audits initiated by private and governmental payors.  If a payor believes there are consistent concerns with a medical practice’s claims, the payor may place the practice under a prepayment review process.  This process can be very concerning to a practice and, in some cases, can place a practice at risk of shutting down.  A previous post provided an overview of standard claims processes versus a prepayment review process.  Prepayment review processes are different depending on which payor you are dealing with and whether the payor is private or government.  Herein, I provide a few tips for dealing specifically with TRICARE/Humana Military regarding a prepayment review process.  If you have questions about an insurance audit or prepayment review process or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

In a previous blog post, I presented three tips for dealing with an audit from any payor.  Those tips remain relevant for trying to end a prepayment review with TRICARE/Humana Military.  The below tips are targeted specifically for dealing with a prepayment review process with TRICARE/Humana Military that is causing harm to your business due to the lack of claims being timely paid.

Tip 1: Get Your Community Liaison Involved

As a TRICARE provider, you have a Community Liaison that you can connect with via email and through the portal.  Your Community Liaison is there to answer your questions and connect you with the right people. Continue reading ›

self-employed-health-insurance-deduction-feature-1280x720-1-e1680719330392Our healthcare and business law firm often assists medical practices in responding to medical record and coding audits initiated by private and governmental payors.  If a payor believes there are consistent concerns with a medical practice’s claims, the payor may place the practice under a prepayment review process.  This process can be very concerning to a practice and, in some cases, can place a practice at risk of shutting down.  If you have questions about an insurance audit or prepayment review process or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Standard Claims Reimbursement Process

Generally, once a medical practice establishes a relationship with a payor, the practice can submit claims electronically that are paid without requiring individual review.  Generally, supporting documentation is not required to be submitted along with the claim. Continue reading ›

health-medical-e1680627379406Our healthcare and business law firm often assists medical practices in responding to medical record and coding audits initiated by private and governmental payors.  Responding to each payor is unique.  The way I might respond to a private payor may differ from how I respond to a government payor.  This post, however, provides a few tried-and-true tips to consider when faced with an audit.  If you have questions about an insurance audit or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Tip 1- Hire Counsel

Although this sounds self-serving, it is not.  Attorneys who are experienced assisting medical practices with responding to insurance audits are well worth their cost.  Continue reading ›

5061-dreamstime_m_28850408-e1680196937118Our healthcare and business law firm often assists provider and medical practice clients with preparing informed consents.  Many clients offer treatments in an off-label use and question whether informed consents are necessary for such use.  Currently, there is no FDA requirement to get a patient’s informed consent, but it may be beneficial for your practice to implement off-label informed consents.  If you have questions about patient consents or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

What Does “Off Label” Mean?

Off label means providing treatment and prescribing medications for conditions or using a dose different than what the FDA has approved.  To become an approved use of a drug or treatment, the FDA must “conduct a careful evaluation of its benefits and risks for that use” and ensure that use “is supported by strong scientific data.”  Continue reading ›

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