Michael Cassidy at Tucker Arensberg, P.C.

Pennsylvania Expands Allowable Procedures for Ambulatory Surgery Center

Pennsylvania Act 70 of 2017, a copy of which is attached, changes the definition of an ambulatory surgical facility by redefining the duration of the “services” to be 24 hours, rather than a 4 hour procedure and 4 hours of...more

3/5/2018 / Ambulatory Surgery Centers , Health Care Providers , Healthcare Facilities

OIG Gainsharing Opinion Facilitates P4P

Although it has been almost a decade since the OIG has issued a gainsharing opinion, OIG Advisory Opinion No. 17-09 confirms the federal government’s support of the pay for performance concept. OIG 17-09 is the first...more

2/14/2018 / Civil Monetary Penalty , Gainsharing , Health Care Providers , OIG , Pay-for-Performance , Value-Based Purchasing

CMS Announces Bundled Payments Care Improvement Model

On January 11, 2018, CMS announced a new voluntary episode payment model (bundled payments for care improvement advanced–BPCI Advanced) that will test a new iteration of bundled payment for the following thirty-two (32)...more

1/23/2018 / BPCI , Bundled Payments , Centers for Medicare & Medicaid Services (CMS) , Hospitals , Medicare

CMS Issues Billing Guidance for Major Joint Replacement (Hip or Knee)

In the January 11, 2018 issue of MLN Connects, CMS has now widely publicized that it issued billing guidance for major joint replacements (hip or knee) in May 2017 at ICN909065. CMS reports that major joint replacement is...more

1/11/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hip Replacement , Hospitals , Medicare , New Guidance

2018 Pennsylvania Approved Medical Records Fees

On December 2, 2017, the Department of Health issued the new maximum fees for duplication of medical records. The link to the Pennsylvania Bulletin Announcement follows...more

12/21/2017 / Department of Health and Human Services (HHS) , Fees , Medical Records

Telehealth, Net Neutrality and the Tipping Point

Telehealth is apparently reaching a critical mass where people are starting to review the potential problems of telehealth, rather than the potential opportunities. In a MedLaw Blog post on December 6, 2017 and my related...more

12/21/2017 / FCC , Net Neutrality , OIG , Telehealth

Telehealth Reaches Tipping Point – Now Included in OIG Audit Plan

Telehealth has apparently reached the tipping point in its significance to the Medicare budget, because OIG has now announced that it will “review Medicare claims for telehealth services provided at distant sites that do not...more

12/7/2017 / Health Care Providers , Medicare , OIG , Telehealth

CMS Merely Soliciting Comments on Including Total Joints as ASC Procedures

CMS released the proposed update for the Hospital Outpatient Perspective Payment System and the Ambulatory Surgery Center System on July 13, 2017, and the release has generated some unexpected controversy regarding the...more

8/28/2017 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Comment Period , Health Care Providers , Hospitals , Medicare , Outpatient Prospective Payment System (OPPS) , Provider Payments

West Virginia Doctor Secures Temporary Restraining Order Against Medicare Exclusion

In Robie v. Price, Dr. Robie successfully obtained a temporary restraining order prohibiting CMS from terminating his Medicare billing privileges prior to the exhaustion of his administrative remedies by the U.S. District...more

8/7/2017 / Administrative Proceedings , Centers for Medicare & Medicaid Services (CMS) , Due Process , Medicare , Physicians , Subject Matter Jurisdiction , TRO

HHS Publishes Health Care Cyber Attack Checklist

HHS has published a very brief guide, in the form of a checklist, to explain the steps for a HIPAA covered entity or business associate to take in response to a cyber related security incident. You can access the checklist at...more

6/26/2017 / Business Associates , Covered Entities , Cyber Attacks , Department of Health and Human Services (HHS) , Health Insurance Portability and Accountability Act (HIPAA) , Incident Response Plans

Texas Telemedicine Law Finally Allows Complete Remote Treatment

The Texas Medical Board and Teladoc have been battling for seven years, and through several rounds of litigation over whether a patient relationship can be established for purposes of providing telemedicine services without...more

6/8/2017 / Governor Abbott , Health Care Providers , Pending Legislation , Physical Presence Test , Physicians , Telemedicine

Western Pennsylvania Hospital Stark/Whistleblower/False Claims Case Provides Real World Guidance For Medical Directors’ Contracts

Emanuele v. Medicor Associates, was presented to the United States District Court for the Western District of Pennsylvania as cross motions for summary judgment, and provides some guidance regarding the Stark requirements for...more

4/13/2017 / False Claims Act (FCA) , Hospitals , Medical Directors , Motion for Summary Judgment , Stark Law , Whistleblower Protection Policies

HHS Issues Rules Expanding OIG’s Exclusion Authorities

On January 12, 2017, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) issued final rules implementing permissive exclusion authorities authorized by the Affordable Care Act expanding...more

1/27/2017 / Affordable Care Act , Exclusions , Final Report , OIG , Social Security Act

FDA Issues Guidance on December 28, 2016 for Postmarket Management of Cybersecurity in Medical Devices

I am repeating the Introduction of the FDA Guidance, and attaching a link to the 30 page document. The Food and Drug Administration (FDA) is issuing this guidance to inform industry and FDA staff of the Agency’s...more

12/28/2016 / Cybersecurity , Food and Drug Administration (FDA) , Guidance Update , Medical Devices

2017 Medicare Telehealth Changes

The 2017 Medicare Physician Fee Schedule finalizes the CMS changes for Telehealth reimbursement and coverage for 2017. The CMS fee schedule document also provides a comprehensive explanation of Medicare Telehealth...more

12/16/2016 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Physician Fee Schedule , Telehealth

Pennsylvania 2017 Medical Record Costs

The Pennsylvania Department of Health published the approved 2017 medical record cost for production of medical charts and records. The notice is attached in the link below....more

12/12/2016 / Department of Health and Human Services (HHS) , Electronic Medical Records , Fees , Medical Records

Independent Medical Staff Denied Title VII Protection

It has not been unusual for employed physicians to seek the protection provided to independent medical staff members through the due process procedures provided by medical staff by-laws. The case of Levitin and Chicago...more

11/1/2016 / Bylaws , Due Process , Employee Definition , Hostile Environment , Peer Review , Physician Hospital Organizations , Physicians , Summary Judgment , Title VII

Basic Contract Issues for New Physician Contracts

When physicians have finally completed the medical education journey, many are confronted with a “physician employment contract,” usually from a hospital or medical practice, which could define the essential terms of their...more

7/28/2016 / Employee Benefits , Employer-Owned Intellectual Property , Employment Contract , Hospitals , Malpractice Insurance , Physician Compensation Arrangements , Physicians , Restrictive Covenants , Termination Clauses , Trade Secrets

CMS Posts Open Payment Data – $7.52 Billion in 2015

CMS published the 2015 Open Payment Data on June 30, 2015. CMS has presented tables in its press release showing the highest paid specialties and highest paying companies. ...more

7/7/2016 / Centers for Medicare & Medicaid Services (CMS) , Genentech , Manufacturers , Medical Devices , Novartis , Open Payments , Pharmaceutical Industry , Physicians , Reporting Requirements

Final 60 Day Overpayment Rule

CMS has issued the final regulations to implement that section of the Affordable Care Act amending the Social Security Act to provide that retention of identified overpayment could be a false claim and be subject to both the...more

2/22/2016 / 60-Day Rule , Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Civil Monetary Penalty , False Claims Act (FCA) , Final Rules , Overpayment

Progress on Medicare Payment Reform

HHS is gearing up to design and implement a revised Medicare payment system. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has designated a merit based incentive payment system (MIPS) as a goal. CMS is...more

2/3/2016 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Medicare , Medicare Access and CHIP Reauthorization (MACRA) , MIPS

10 Significant Physician Contracting Mistakes

1. Failure to Begin with the End in Mind. The most important provisions of your employment contract will be the provisions governing your termination rights, for two reasons. First, if the relationship goes well, chances are...more

1/21/2016 / Contract Drafting , Employment Contract , Hiring & Firing , Malpractice Insurance , Physicians , Restrictive Covenants

Physician Practices Face Anti-Trust Risks, Too

On December 18, 2015, the Federal Trade Commission (FTC) announced a settlement with Keystone Orthopaedic Associates Specialists and Orthopaedic Associates of Reading, LTD, which were two of six orthopedic practices in Berks...more

1/12/2016 / Anti-Competitive , Consent Order , Federal Trade Commission (FTC) , Physicians , Settlement

FTC and Pennsylvania Challenge Penn State Hershey’s Planned Merger with PinnacleHealth System

BNA has reported the planned merger of Penn State Hershey Medical Center with PinnacleHealth System will be challenged in federal court by federal and state officials. The Federal Trade Commission and Pennsylvania’s...more

1/5/2016 / Anticompetitive Agreements , Attorney General , Federal Trade Commission (FTC) , Healthcare Costs , Hospital Mergers , Injunctive Relief

Medical Records Fees for EHR

You might have not noticed in the last blog post that there is a provision in the Pennsylvania Notice regarding electronic health records. The Notice does not establish a fee for electronic health records. ...more

12/22/2015 / Electronic Medical Records , Health Care Providers

Michael Cassidy

Tucker Arensberg, P.C.

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