News & Analysis as of

Billing

California’s Surprising New “No Surprise” Health Care Billing Law

by King & Spalding on

As it “rolls out” over time, California’s new “No Surprise” billing law will prohibit certain physicians and other clinicians from billing and collecting more than applicable deductibles and co-paysfrom their patients....more

Concierge Medicine – Making it Financially Attractive to Patients

by Farrell Fritz, P.C. on

In follow-up to our prior blog post, Concierge Medicine – Is it for you?, we recognize that while a concierge or direct-pay practice might be a good choice for a physician or physician practice group, patients do not...more

Ambulance Service Declared a Learned Profession in NJ

by Faegre Baker Daniels on

Who knew? In New Jersey ambulance service is considered a “learned profession,” up there with medicine and law. And that classification provides more than prestige. It means exemption from the state’s Consumer Fraud Act...more

Alternative Fee Arrangements When the Insurer Is Footing the Bill

Clients regularly ask their counsel to propose alternative fee arrangements and they are growing in popularity. While these arrangements can be beneficial for clients, they should be carefully considered when an insurance...more

Is Your Surgery Center Ready for California’s Surprise Medical Billing Law?

by Nossaman LLP on

A new California law (AB 72) limits the amount that out-of-network surgeons and other health care professionals may bill patients for covered non-emergency services provided at a contracted facility, such as an ambulatory...more

July 2017 FCC Meeting Recap: FCC Plans to Strengthen and Expand “Slamming” and “Cramming” Rules

by Kelley Drye & Warren LLP on

At its July 2017 Open Meeting, the Federal Communications Commission (“FCC”) adopted a Notice of Proposed Rulemaking (“NPRM”) designed to strengthen and expand consumer protections against “slamming” and “cramming.” Slamming...more

Attorney Billing Records Not Categorically Protected by California Attorney-Client Privilege

by Holland & Knight LLP on

Holland & Knight issued an alert in June 2015, written by Allison Martin Rhodes and Craig S. Weinstein, regarding an earlier California Court of Appeal ruling in this case. This alert provides an update after a December 2016...more

501(r) Audits Are Here: What You Need to Know

by Nilan Johnson Lewis PA on

The Affordable Care Act imposed new requirements on tax-exempt hospitals under Section 501(r) of the Internal Revenue Code. Section 501(r) and its implementing regulations present a complex framework intended to promote...more

"Double Dip" Effectively Approved by Center for Medicare and Medicaid Services

by Hogan Lovells on

Last week the Centers for Medicare and Medicaid Services (CMS) issued Release No. 104 to Manufacturers and Release No. 180, which invalidated earlier agency releases addressing the treatment under the Medicaid drug rebate...more

FCC Provides Guidance on Inability to Pay Analysis in Enforcement Actions; Significantly Reduces Slamming/Cramming Penalty

by Kelley Drye & Warren LLP on

The Federal Communications Commission (FCC) reduced the penalty assessed against a long distance carrier by over $6 million in a Forfeiture Order issued earlier this week, after the carrier demonstrated an inability to pay...more

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

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

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