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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 ›

rawpixel-703120-unsplash-e1678464455417Our healthcare and business law firm often assists physicians and other providers in employment matters, from reviewing proposed contracts to litigating non-compete matters.  We’ve written previous material on physician employment, including Keys to Negotiating a Good Contract and Physician Non-Compete Agreements.  As mentioned in our previous post, our firm has recently been dealing with issues raised by co-terminus language, or language providing that a physician’s hospital clinical privileges automatically terminate when the employment contract is terminated.  The previous post provided an overview of co-terminus language and potential issues raised by such language.  This post focuses on possible ways a physician can protect herself or himself from those issues. If you have NPDB or employment questions 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.

 

Although there may be many ways for a physician to protect themselves from the issues posed by co-terminus language (which issues we detailed in our previous blog post available here), below are a few ways we have dealt with in the past, some in the contract negotiation phase and others are actions to take after employment has ended.  Note, these actions do not insulate a physician from issues, but rather add protections to try and reduce the chance that the physician is met with problems relating to clinical privileges. Continue reading ›

understanding-physician-employment-contracts-e1677703586595Our healthcare and business law firm often assists physicians and other providers in employment matters, from reviewing proposed contracts to litigating non-compete matters.  Physician employment agreements are often between 15 to 30 pages long, but many important terms are imbedded in those pages.  We’ve written previous material on physician employment, including Keys to Negotiating a Good Contract and Physician Non-Compete Agreements.  Our firm has recently been dealing with issues raised by co-terminus language, or language providing that a physician’s hospital clinical privileges automatically terminate when the employment contract is terminated.  Herein, I provide (1) an overview of the language and (2) potential issues raised by such language.  The next blog post will focus on possible ways a physician can protect themselves from those issues. If you have NPDB or employment questions 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.

  1. Co-Terminus Language

Here is an example of co-terminus language:

Physician’s Medical Staff Membership and privileges shall terminate concurrently with the termination or expiration of this Agreement. Any provision of Company policies to the contrary notwithstanding, Physician and the Company agree that the Company has no duty to provide any notice, hearing or review in connection with the termination or suspension of Physician’s Medical Staff Membership and privileges hereunder.

The point of co-terminus language is so that the hospital does not have to follow their medical staff bylaws, which typically provide that privileges must either be voluntarily resigned or involuntarily removed. Continue reading ›

opioid-painkillers-crisis-and-drug-abuse-concept-o-49X49YX-e1676319930781After 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 pain management prescribing questions 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.

First, the updated guidance “is intended for clinicians who are treating outpatients aged ≥18 years with acute (duration of <1 month), subacute (duration of 1–3 months), or chronic (duration of >3 months) pain, and excludes pain management related to sickle cell disease, cancer-related pain treatment, palliative care, and end-of-life care.” Continue reading ›

nurse-practitioner-vs-primary-care-doctor-002-e1675797754824As 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 practice-related questions 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.

Prior to the autonomous practice law, nurse practitioners could practice in Florida pursuant to a collaborative/supervisory protocol as defined by Florida Statute 464.012Florida Statute 464.0123 allows the Florida Board of Nursing to register an individual as an advanced practice registered nurse or as an autonomous advanced practice registered nurse if the nurse practitioner meets the following criteria: Continue reading ›

imagesOur healthcare and business law firm previously published a blog post on the federal telemedicine rules.  Both Federal and State rules govern the provision of telemedicine.  Each state’s rules governing telemedicine are different, but the applicable laws and rules are generally found in the state medical board’s rules, insurance codes, and when applicable, Medicaid rules.  This post focuses specifically on Florida’s telemedicine prescribing rules.  Our firm previously posted an overview of Florida’s general telemedicine rules.  Keep in mind that this post discusses the current laws as of the date written and do not include any changes to the laws after being posted.  If you have questions about telemedicine rules 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.

Florida Rules on Prescribing Based on a Telemedicine Visit

Florida is rather generous in its prescribing rules for telemedicine.  Before July 1, 2022, the law restricted prescribing all controlled substances except for certain situations.  Continue reading ›

MM-0220-Telemedicine-iStock-e1581381176331-1024x814-1-e1631301250783Our healthcare and business law firm previously published a blog post on the federal telemedicine rules.  Both Federal and State rules govern the provision of telemedicine.  Each state’s rules governing telemedicine are different, but the applicable laws and rules are generally found in the state medical board’s rules or position statements, insurance code, and when applicable, Medicaid rules.  This post focuses specifically on the telemedicine rules applicable to the practice of telemedicine in Florida.  This post does not discuss telemedicine prescribing rules or Medicaid rules.  If you have questions about telemedicine rules 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.

Florida Rules

The Florida telehealth rules are set out in Florida Statute 456.47, which was modified in 2022 through Senate Bill 312.  Florida allows a limited telemedicine license for those without a full medical license, but, in general, the same rules apply regardless of whether a provider has a full medical license or limited telemedicine license. Continue reading ›

iStock-1014086596-1000x500-2-e1661804634296Our healthcare and business law firm previously published a blog post on the federal telemedicine rules.  Both Federal and State rules govern the provision of telemedicine.  Each state’s rules governing telemedicine are different, but the applicable laws and rules are generally found in the state medical board’s rules, insurance code, and when applicable, Medicaid rules.  This post focuses specifically on North Carolina’s telemedicine prescribing rules.  Our firm previously posted an overview of North Carolina’s general telemedicine rules.  If you have questions about telemedicine rules 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.

North Carolina Rules on Prescribing Based on a Telemedicine Visit

North Carolina has yet to pass any laws on telemedicine, but the North Carolina Medical Board (“Medical Board” or “NCMB”) has published telemedicine policies available on its website, here. Below is an overview of some requirements currently in North Carolina governing prescribing practices from a telemedicine visit. Continue reading ›

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