News & Analysis as of

Billing

Surprise Billing Legislation Update

by Arnall Golden Gregory LLP on

In this year’s legislative session, members of Georgia’s House and Senate attempted to pass legislation on “surprise billing” for healthcare consumers. This proposed legislation sought to establish notice and disclosure...more

WARNING: New York Percentage Billing Arrangements Under Attack. Medicaid Frad Unit Is Seeking Recoupment from Providers Using...

New York’s Medicaid Fraud Control Unit (“MFCU”) has sent demand letters seeking recoupment from certain healthcare providers in New York State who have percentage of collection arrangements with their outside billing...more

5 Fundamentals of Collecting Fees

by Dentons on

It pays to implement an effective billing system—literally. On the front end, having a system in place increases realization rates because it gets money in the door. On the back end, fee disputes and related malpractice...more

HHS Secretary Backs Medicare Balance Billing

by Faegre Baker Daniels on

Generally speaking, patients really dislike balance billing. Sometimes called “surprise billing,” “balance billing” refers to billing a patient for the difference between the health care provider’s charge and the amount a...more

Recent Changes to Medicare “Incident To” Billing Rules

by Ruder Ware on

Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules. The "incident to" rules permit services...more

California High Court Questions Privileged Nature of Attorney Invoices

In Disney’s The Lion King, the wise lion Mufasa sits atop a rock crag with his heir, the cub Simba, looking down on the Serengeti below. “Everything the light touches,” Mufasa instructs, “is our kingdom.” A similar scene...more

Judge Cuts Over $10M from Attorney Fees Due to Use of Temporary Attorneys for Document Review: eDiscovery Case Law

by CloudNine on

The use of temporary associates for document review (and billing at normal staff associate rates) caused a federal judge in Manhattan to reduce the request for attorney fees by $10.3 million in a settlement of a securities...more

California Supreme Court Concludes Attorney Invoices Privileged During Ongoing Litigation

Attorney invoices may be protected in their entirety by the attorney-client privilege during ongoing litigation. After litigation has concluded, however, those same invoices may be discoverable. So concludes the California...more

Let it go

by Ary Rosenbaum on

One thing I’ve learned over time is not to bottle up anger. Ever since I was a kid, I was passive-aggressive, I wouldn’t confront people with issues that bothered me and I’d bottle it up until I blew up later down the line. I...more

Legal Invoices to Public Agencies in California May Be Exempt from Disclosure

by Best Best & Krieger LLP on

In a case that pitted government transparency against a public agency’s interest in confidential communications with its attorney, the California Supreme Court came down on the side of protecting attorney-client privileged...more

Medical Litigation Newsletter - December 2016

by Hinshaw & Culbertson LLP on

Defending Audits Before They Happen: A Practical Guide to Documenting to Sustain A Challenge to E/M Codes - Although many believe malpractice suits to be the primary risk-management issue facing healthcare providers, an...more

New POS Code for Telehealth Distant Site Providers

by Baker Ober Health Law on

A new Place of Services or POS code for Telehealth services (POS 02) will go into effect on January 1, 2017. The descriptor for the code, which is for use by the physician or other clinician furnishing telehealth services...more

2017 OPPS Final Rule: Payment to Off-Campus Provider-Based Departments

by Stinson Leonard Street on

On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the 2017 Medicare Outpatient Prospective Payment System (OPPS) Final Rule. One aspect of this rule is the implementation of payment decreases for...more

Provider Self-Disclosure Decisions – Voluntary Disclosure Process

by Ruder Ware on

The decision whether or not to voluntarily disclose non-compliance to the government can be very difficult. Not every case is clear. Clearly not every situation where there has been a billing error amounts to fraud or...more

Healthcare Litigation - October 2016

Recently, California Governor Jerry Brown signed into law “surprise medical bill legislation,” seeking to curb out-of-network medical bills. This law, designated AB 72, amends California’s Health and Safety Code to limit the...more

DOJ Announces Settlement with Tuomey CEO Following Yates Memo Directive to Hold Individuals Accountable

by King & Spalding on

The Department of Justice’s recent settlement with a healthcare system executive indicates a continued focus on pursuing individuals in enforcement actions. On September 27, 2016, the DOJ announced it reached a $1 million...more

Billing Companies Beware – OIG Signals a Crackdown on Fraud and Abuse at All Levels

In an unprecedented administrative action, the U.S. Department of Health & Human Services Office of the Inspector General (“HHS-OIG”) penalized a medical billing company for preparing and submitting claims to Medicare for...more

Supplement Marketer Settles FTC’s Negative Option-Related Lawsuit

by Klein Moynihan Turco LLP on

Nutritional supplement marketer, NutraClick, has entered into a settlement with the Federal Trade Commission (“FTC”), ending a lawsuit that the agency initiated for alleged violations of the Federal Trade Commission Act and...more

OCC, CFPB Charge Bank With Illegal Credit Card Practices

Two regulators have forced one bank to pay $35 million for allegedly improper credit card practices—including fines owed to both the Office of the Comptroller of the Currency (OCC) and the Consumer Financial Protection Bureau...more

CFPB Month in Review for August 2016

In case you missed it, here is what the Consumer Financial Protection Bureau (CFPB) was up to over the last month: Enforcement Actions and Litigation - Enforcement Action Against First National Bank of Omaha...more

No More Surprises: Florida Ends Certain Medical Balance Billing

by Carlton Fields on

"Surprise medical billing" occurs when a patient receives care at a facility and receives treatment from a provider, such as an anesthesiologist or radiologist, who is not contracted with the patient’s health insurance plan....more

Use of Modifier 25 - 2017 Medicare Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have reviewed the use of Modifier 25 to unbundle payments for evaluation and management (E/M) services when a procedure is...more

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

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

by McDermott Will & Emery on

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

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