Little Health Law Blog
Both 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 ›
Our healthcare and business law firm works with many providers and other allied health professionals who are beginning their journeys of opening a Medical Spa. They have been 
Our healthcare and business law firm works with many providers and other allied health professionals who are beginning their journeys of opening a Medical Spa. Medical Spas have been 
Our 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 
Our 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 
Our 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, 
After the CDC issued its 2016 Opioid Prescribing Guideline, which focused on recommendations for primary care physicians, many physicians greatly limited prescribing opioids. This was in response to the opioid epidemic in our country which had an impact on reducing opioid abuse. However, it also may have left patients undertreated for pain given the 2016 guideline’s emphasis on not prescribing opioids. In November 2022, the CDC issued updated guidance for a broader group of clinicians. This blog series provides an overview of the more-than-60-page CDC guidance. This first blog will provide an overview of what the guidance is intended to accomplish and how it is presented. Our attorneys are experienced in advising healthcare businesses and pain management practices. If you have 
As a healthcare and business law firm, we have many clients who either are or wish to hire nurse practitioners around the country. Each state has very specific, and often complicated, laws and rules governing nurse practitioner practices. In 2020, Florida introduced a new law allowing certain nurse practitioners to practice autonomously, which Florida has sense been expanding on and clarifying. Herein is an overview of Florida’s autonomous practice law. If you have scope of practice or other 
Our healthcare and business law firm previously published a blog post on the 
Our healthcare and business law firm previously published a blog post on the