Billing

News & Analysis as of

After New York, Florida Curbs Surprise Bills for Emergency and Out-of-Network Services

It is generally understood that if a managed care member utilizes the services of a non-participating provider, the member could incur significant out of pocket expenses. However, there are instances where a member may...more

Review Your Hourly Fee Agreement

Hourly billing for legal services has been criticized for, among other things, discouraging attorney efficiency and providing the client with no predictability of cost (see, e.g., ABA Commission on Billable Hours Report...more

Surprise Medical Bills? The Florida Legislature Offers Some Relief!

With House Bill 221, the last bill to pass during the 2016 legislative session, the Florida legislature took a significant step towards reducing uncertainty for medical costs for persons with Preferred Provider Organization...more

Program Integrity Changes to the Medicare Provider Enrollment Process

On March 1, 2016, the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) entitled “Medicare, Medicaid, and Children’s Health Insurance...more

Portable X-Ray Suppliers Receive Clearer Transportation Billing Guidance

Included among the 2016 Medicare Physician Fee Schedule (MPFS) changes is clarification from CMS regarding how it expects transportation charges billed by portable x-ray suppliers to be prorated among the patients receiving...more

Catastrophe Averted…What’s Next for ICD-10?

If the October 1, 2015 ICD-10 transition buildup felt to you like Y2K all over again, then you are not alone. Although some hospitals have reported delays in payments, physician practices have not experienced delays in...more

Appellate Court Affirms Sanctions in Light of “Delay Tactics” and Spoliation (Massachusetts)

Long Bay Management Co. v. Haese, 2015 WL 7213811 (Mass. App. Ct. Nov. 17, 2015) - In this overbilling dispute, the defendants appealed a judgment pursuant to an order of default sanctions and an order assessing damages,...more

District Court Rejects FCA Claim Against Healthcare Provider That Submitted False Claims But Did So Without Necessary Mental State

Healthcare provider Fresenius Medical Care North America claimed victory in a False Claims Act (“FCA”) lawsuit recently when a federal district court ruled that there was no evidence that its practice of billing for...more

New Hampshire Federal Court Rules That England’s Statute Of Limitations Applies To A Cedent’s Breach Of Contract Claim

In a diversity action based upon breach of a facultative reinsurance certificate, a New Hampshire federal court recently held that England’s six-year statute of limitations governed a cedent’s contract claim, rejecting the...more

Torts – Effect of Howell Decision on Purchased Medical Liens

Anna Uspenskaya v. Clare Meline - Court of Appeal, Third District (October 28, 2015) - Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541 was a landmark case in which the California Supreme Court...more

CFPB Monthly Complaint Report Highlights Credit Cards

On October 27, the CFPB released its Monthly Complaint Report focusing on credit card complaints. The CFPB has received over 79,000 credit card-related complaints since it began receiving those complaints in July 2011. ...more

New Budget Bill May Signal End of Provider-Based Status

Hospitals that seek to establish provider-based OPDs should complete their work soon. A near-final discussion draft of a House budget bill, which the White House has apparently agreed to in principle, would end the...more

Budget Proposal Would Limit Provider-Based Status - New Off-Campus Departments Limited to Physician Fee Schedule or ASC Payment...

On October 26, 2015, Congressional and White House budget negotiators released the legislative text of the Bipartisan Budget Act of 2015. The Act is aimed primarily at lifting the Federal debt limit and avoiding a looming...more

FCC Clarifies the Requirements for Sending Wireless Calls and Text Messages to Patients

The Federal Communications Commission ("FCC") recently clarified questions surrounding wireless patient calls and text messages, and the requirements of the Telephone Consumer Protection Act (“TCPA”). The TCPA protects...more

OIG Identifies Potentially Improper Medicare Ambulance Payments

In response to rising Medicare Part B payments for ambulance transports and continuing concerns about program vulnerabilities, the OIG has once again reviewed Medicare claims for ambulance services. The OIG estimates that...more

OIG Recommends Reevaluation of Medicare Payment System for Skilled Nursing Facilities

The HHS Office of Inspector General (OIG) released a report on September 30, 2015 finding that Medicare payments for therapy services provided at skilled nursing facilities (SNFs) greatly exceeded the cost of such services. ...more

OIG Flags $171 Million in Potentially Questionable Billing for Medicare Ophthalmology Services

The OIG has issued a report entitled “Questionable Billing for Medicare Ophthalmology Services.” The OIG concludes that most Medicare providers billing for ophthalmology services in 2012 did not demonstrate what the OIG...more

Fast Alert: OIG Calls For Reevaluation Of Medicare Therapy Billing

On September 30, 2015, the Office of Inspector General (OIG) published a report titled, "The Medicare System For Skilled Nursing Facilities Needs To Be Evaluated" in response to growing concerns over Medicare's payment system...more

CFPB Continues to Target Add-On Credit Products

The Consumer Financial Protection Bureau (CFPB) has stepped up its enforcement actions alleging deceptive and unfair practices in marketing and billing for add-on credit protection products. Add-on products have been one of...more

OIG Releases Report on Questionable Billing for Medicare Ophthalmology Services

On September 15, 2015, OIG released a report examining the extent to which ophthalmology services are vulnerable to fraud, waste, and abuse. According to OIG, Medicare paid $6.7 billion to 44,960 providers for ophthalmology...more

Every assertion of client ownership weakens a firm

“It’s my client.” “I get the billings.” Even the magnanimous say, “I”ll share the billings.” In court, you often hear lawyers refer to “my client.” Each own of these assertions of ownership weakens everyone involved. Most...more

The 411 on Standing Orders

When it comes to service, providing our clients with the best experience is our top priority. One way we achieve this is through catering to our clients’ needs. From booking hotel conference rooms for depositions across the...more

Law Firm Signal and Noise: Telltale signs of signal

In Part 1 of this post, I noted how law firms had become so adept at creating “noise” about various topics–client service and AFAs for example, they they effectively drowned out any signal on these topics. Much of what firms...more

Why ValoremNext?

A lot of people have asked why we chose this name for our prevention platform. I wanted to answer those many inquiries. My new partner Jeff Carr, the iconic former General Counsel of FMC Technologies, sometime ago defined the...more

What were they thinking?

I can’t even make stuff like this up. Lawyers and invoices are a toxic combination, but the AmLaw 200 firms that are responsible for these examples have people who are supposed to prevent the lawyers from revealing their...more

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