Michael Cassidy

Michael Cassidy

Tucker Arensberg, P.C.

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CMS Designates Global Surgery as “Potentially Misvalued Services”

In the recently proposed 2015 Physician Fee Schedule, CMS devoted significant resources to discussing potentially misvalued services, which I believe is code for places where CMS would like to reduce reimbursement. One of the...more

7/22/2014 - CMS Healthcare Physician Medicare Reimbursements Surgery

CMS Seeking Comments Regarding Expanding Coverage for Secondary Interpretation of Images

In the proposed 2015 Medicare Physician Fee Schedule, CMS is seeking comments regarding expanding coverage for secondary interpretation of diagnostic imaging....more

7/22/2014 - CMS Diagnostic Imaging Services Healthcare Physician Medicare Reimbursements

CMS Releases Proposed 2015 Physician Fee Schedule and Pojects 20.9% SGR Reduction

CMS has issued the Proposed 2015 Physician Fee Schedule and Fact Sheets for specific issues (ASC, ESRD, Home Health, Physician Quality Programs)....more

7/16/2014 - CMS Healthcare Physician Fee Schedule Physician SGR Formula Physicians

OIG Report: Questionable Billing for Medicare Part B Clinical Laboratory Services

Perhaps not coincidentally, immediately following the release of the Questionable Laboratory Payments Special Fraud Alert by the OIG, posted yesterday on the Med Law Blog, the OIG has followed up with Audit Report OIG –...more

7/11/2014 - Clinical Laboratories CMS Healthcare Medicare Medicare Part B OIG

Anti-Kickback Laboratory Enforcement Actions – Special Fraud Alert

There has been significantly enhanced scrutiny of financial relationships between referring physicians by both the Office of Inspector General (OIG) and Pennsylvania authorities....more

7/11/2014 - Anti-Kickback Statute Enforcement Enforcement Actions Fraud Kickbacks OIG

AMA Issues New Telemedicine Policy

Last week, the American Medical Association (AMA) issued a new report regarding coverage of and payment for telemedicine (CMS Report 7-A-14). The report recognizes the telemedicine is a “key innovation in support of health...more

6/17/2014 - American Medical Association CMS Healthcare Telemedicine

Ohio Court Reiterates Peer Review Privilege Applies Only to Formal Peer Review Actions

A Hospital in Ohio tried to prevent access to a patient incident report on the basis of Peer Review Privilege. The Hospital claimed that, since the incident report was reviewed by the Hospital Peer Review Committee, the...more

6/6/2014 - Healthcare Hospitals Peer Review Privilege Waivers

New CMS Rules Reduce Role of Medical Staff

The American Health Lawyers Association Regulatory Accreditation and Payment Practice Group (RAPPG) has issued an email alert regarding the issuance of a final rule by CMS intending to streamline Medicare regulatory...more

5/22/2014 - CMS Healthcare Healthcare Professionals Medicaid Expansion Medicare

CMS Cancels ICD-10 Testing

The MLN Connects™ Provider eNews contains important news, announcements, and updates for health care professionals. ICD-10 Compliance Date - On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA)...more

5/5/2014 - CMS HHS HIPAA ICD Codes MACs Protecting Access to Medicare Act

Physical Therapy Provider Enters into HIPAA Settlement

U.S. Department of Health and Human Services Office for Civil Rights (OCR) recently announced yet another enforcement action. Specifically, OCR opened a compliance review of Concentra Health Services (Concentra) upon...more

4/25/2014 - Compliance Data Breach Data Protection Encryption Enforcement Actions Healthcare HHS HIPAA OCR

Medical Staff Application Release Bars Physician Credentialing Claim

In Copeland v. MidMichigan Regional Medical Center, a Michigan State Appellate Court affirmed a trial court’s grant of summary judgment in favor of the Hospital, based upon both HCQIA immunity and a general release signed by...more

4/24/2014 - HCQIA Healthcare Healthcare Professionals Hospitals Release Agreements Summary Judgment

New York Federal Court Takes Different Stance on Medical Staff Bylaws

On April 14, MedLaw Blog posted a comment about Villare v. Beebe Medical Center, a case in which a Delaware trial court granted summary judgment on the basis that the medical staff bylaws were held not to constitute a...more

4/18/2014 - Beebe Medical Center Bylaws Due Process Hospitals Physician Ownership Summary Judgment

Medical Staff Bylaws Are Not Contracts in Delaware

One of the fundamental issues in credentialing disputes is whether the Medical Staff Bylaws constitute contracts between the Hospital and the individual physicians. If the Medical Staff Bylaws do constitute a contract, then...more

4/15/2014 - Bylaws Contract Disputes Credentialing HCQIA Hospitals Physicians

President Obama Signs the Protecting Access to Medicare Act of 2014

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from...more

4/3/2014 - Healthcare Healthcare Reform Medicare

MGMA Special Alert – SGR Repeal

Senate approves House-passed SGR patch - Today, by a vote of 64-35, the Senate agreed to legislation passed by the House of Representatives, H.R. 4302, which delays for one year a 24% cut to Medicare physician...more

4/1/2014 - Healthcare Medicare Physician SGR Formula

Latest SGR Repeal News from MGMA

Today the House of Representatives passed by voice vote H.R. 4302, which would temporarily delay the 24% cut to Medicare physician payments resulting from the sustainable growth rate (SGR) formula for one year. MGMA has...more

3/28/2014 - Affordable Care Act Healthcare Healthcare Reform Physician SGR Formula

Practical considerations to protect against being ‘out of network’

Practical considerations to protect against being ‘out of network’ The disengagement of Highmark and UPMC is looming on the horizon; most of the hospital participation agreements between these two competing healthcare...more

3/25/2014 - Healthcare Hospitals Out of Network Provider

Federation of State Medical Boards to Vote on Telemedicine Policy

The March 20th edition of Modern Healthcare reports on a “patient centered telemedicine policy” to be voted on by the Federation of State Medical Boards (FSMB). I’ve attached links to both the article and to the FSMB model...more

3/25/2014 - Healthcare Medical Liability Medical Malpractice Telemedicine

Physician Obtains Injunction Preserving Clinical Privileges Despite Attempted Exclusive Contract

Despite the many cases acknowledging the right of hospitals to enter into exclusive contracts, there is always the issue of what happens with the existing clinical privileges and medical staff memberships of the physicians...more

3/21/2014 - Contract Formation Exclusive Dealing Agreements Healthcare Injunctions Physicians

Compliance Audit Information May Not Be Attorney Client Privileged

Attorneys routinely advise clients conducting audits and investigations that the audit or investigation should be conducted by outside counsel in order to establish attorney client privilege. ...more

3/20/2014 - Attorney-Client Privilege Audits Compliance Corporate Counsel

California Decision Allows Physician to Challenge Sham Peer Review as Whistleblower Retaliation

In Fahlen v. Sutter Central Valley Hospitals, the California Supreme Court found: A physician is not required to first exhaust his administrative remedies through the medical staff appeals process in order to...more

3/11/2014 - Healthcare Peer Review Physicians Retaliation Whistleblower Protection Policies Whistleblowers

2014 OIG Work Plan: Questionable Billing Patterns for Part B Services During Nursing Home Stays

The 2014 OIG Work Plan includes the following: Billing and Payments. We will identify questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home...more

2/17/2014 - Billing False Billing Medicare Medicare Part B Nursing Homes OIG Work Plans

2014 OIG Work Plan: Impact of Provider-Based Status on Medicare Billing

The 2014 OIG Work Plan includes the following: Policies and Practices. We will determine the impact of subordinate facilities in hospitals billing Medicare as being hospital based (provider based) and the extent to...more

2/17/2014 - Healthcare Hospitals Medicare OIG Work Plans

2014 OIG Work Plan: Oversight of Hospital Privileging

The 2014 OIG Work Plan includes the following: Quality of Care and Safety. We will determine how hospitals assess medical staff candidates prior to granting initial privileges, including verification of credentials and...more

2/17/2014 - Healthcare Healthcare Reform Hospitals OIG

Joint SGR Repeal Bill Agreed Upon, Moving to Full Congress

New joint legislation to repeal Medicare’s failed SGR formula is advancing to both chambers of Congress following an agreement announced Thursday by the three committees that put forth repeal bills earlier this...more

2/7/2014 - Healthcare Medicare Physician SGR Formula Physicians

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