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 ›
On 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.
For the better part of the last three years, many healthcare providers either voluntarily or by force have put many of the mandated HIPAA self-assessment audit requirements on the back burner. As has been seen most recently, that is all about to change…significantly.
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 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 
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 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 
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,