Billing

News & Analysis as of

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

FCA 60-Day Repayment Provision Runs from Discovery of Potential Overpayment

The U.S. District Court for the Southern District of New York issued the first decision directly addressing when an overpayment is “identified” for purposes of starting the 60-day repayment clock under the federal False...more

Washington Healthcare Update

This Week: Bipartisan Senate Letter Questions HHS and CMS on Details of State ACA Waivers...OMB Is Reviewing Final Medicaid-Covered Outpatient Drug Rule...Delaware Forgoes Transition to State-Based Exchange....more

Payment is due at the time services are rendered

Typically, physicians collect co-payments from patients when services are provided, submit claims for reimbursement to government and commercial payers, and then send bills to patients for the balance owing. The payment and...more

The Corporate Practice Prohibition in New York: What We Can Learn From the ADMI Settlement

One of the most frequently asked questions posed to healthcare lawyers is whether State X has a prohibition on the corporate practice of medicine, nursing or other profession, and if so, whether the prohibition is enforced. ...more

CFPB Reaches $700 Million Settlement to Resolve Credit Card Ancillary Products Investigation

On July 21, the CFPB announced a nearly $700 million settlement against a leading financial institution and its subsidiaries. According to the consent order, the Bureau alleges that the entities engaged in deceptive...more

OIG Recommends Improvements to Skilled Nursing Facility Billing Policies Regarding Changes in Therapy

The Department of Health and Human Services Office of Inspector General (OIG) recently issued a report that calls for CMS to accelerate its efforts to implement a new method for paying for changes in skilled nursing facility...more

Alternative Fee Arrangements

Clients and law firms sometimes talk about "Alternative Fee Arrangements" (or "AFAs") without understanding what they entail. Best understood, the term describes any arrangement other than payment based purely on hourly...more

Can My Hospital Bill Medicare for Telehealth Chronic Care Management?

CMS just introduced proposed rules to clarify the requirements and payment opportunities when hospitals want to bill Medicare for Chronic Care Management (“CCM”) services. CCM is an exciting service covered by Medicare...more

OIG Issues New Report On SNF Billing For Therapy Services

On June 5, 2015, the Department of Health and Human Services Office of Inspector General (OIG) released another study in its continuing scrutiny of skilled nursing facilities (SNFs) and therapy services: Skilled Nursing...more

New Law Continues to Require Out-of-Network Facility-Based Physicians to Notify Patients of Mediation Rights

Early last week, Gov. Greg Abbott signed SB 481 into law. The new law, which will become effective on September 1st, gives Texas consumers the option to mediate medical bills that they receive from out-of-network...more

The Consumer Financial Protection Bureau's cases against Sprint and Verizon for Mobile Cramming - Blog: Consumer Financial...

Today we’re taking a look at the Consumer Financial Protection Bureau’s cases against Sprint Corporation (“Sprint”) and Cellco Partnership d/b/a Verizon Wireless (“Verizon”) for mobile cramming. For starters, what does...more

California Law: Attorney Billing Records Protected by Attorney-Client Privilege - A Closer Look at County of Los Angeles Board of...

In an important new decision, the California Court of Appeal held in County of Los Angeles Board of Supervisors v. Superior Court (ACLU of Southern California) that attorney invoices are confidential in nature and are...more

CFPB Files Proposed Consent Orders Related to Wireless Billing Practices

On May 12, 2015, the Consumer Financial Protection Bureau (the “CFPB”) filed proposed consent orders in federal courts that would settle allegations that two wireless carriers unfairly permitted their customers to be charged...more

Surprise Bills Laws Enacted in California and New York

What Do They Mean for Providers? - Both California and New York have recently enacted so-called “Surprise Bills Laws” that require out-of-network providers to give notice to patients that a particular item or service...more

Attorney Billing Invoices Privileged From Disclosure Under PRA

California Court of Appeal Rules Attorney-Client Privilege Exemption Covers Billing Invoices - Billing invoices sent by an attorney to a client are exempt from disclosure under the California Public Records Act, a...more

Selected CMS Guidance for Billing for Skilled Nursing Facility Services

Skilled nursing facilities (SNFs) should take note of the updates and clarifications set forth in Medlearn Matters article 8997, issued by the CMS on March 13, 2015. Medlearn Matters article 8997 updates the chapters in the...more

Behavioral Health Billing Alert

Providers of behavioral health services should be aware that the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), released in May 2013 after more than ten years in...more

Timekeeping company argues lawyers using AFAs still need to keep time

One of the great things about non-hourly billing is that it frees you from the tyranny of timesheets. You stop thinking about billing and start thinking about results, about outputs, about deliverables. That approach is an...more

Time Records Are Not Just for Hourly Billing

Many attorneys, especially those in small offices, limit their timekeeping efforts to cases billed on an hourly basis. This can be a big mistake! Here’s why....more

Lawyers Can’t Help Themselves: Client Gouging is just a way of life

In reading my morning mail, this post caught my eye: Don’t Lose Your Shirt When Raising Fees. So I read the post, written by the CFO of a firm named Rivkin Radler. It contains 5 suggestions on how to raise your rates and feel...more

An open invitation

Sometime last summer, my friend Peter Carayannis of Conduit Law reached out and asked if Conduit could use our Value Adjustment Line on Conduit’s invoice. We were thrilled to say yes, much as our friends at Summit Law Group...more

FTC $19 Million Settlement with Google: Unauthorized In-App Charges Are Not Child’s Play

The FTC recently approved a final Order resolving allegations that Google unfairly billed customers millions of dollars for unauthorized charges made by children using mobile apps downloaded from the Google Play app store....more

Medical Billing Provider and its Former CEO Settle FTC Charges That They Misled Consumers About Collection of Personal Health Data

In an age when many of us briskly scroll through website terms and conditions and check, “I agree” without thinking, how should businesses design their websites to obtain proper authorization to access users’ sensitive...more

New Rule Permits CMS to Revoke Medicare Billing Privileges for Providers/Suppliers with “Pattern or Practice” of Denied Claims

On December 5, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule titled “Requirements for Medicare Incentive Reward Program and Provider Enrollment” (“the Rule”). The Rule implemented several...more

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