Effective January 1, 2016, the following fees may be charged by a health care facility or health care provider in response to a request for production of medical charts or records...more
The following issues have been resolved over the last month, at least through June 30, 2019, which is the expiration date of the Consent Decrees entered into with the approval of the Commonwealth Court by the parties in June...more
PBGH just recently sent out a client alert regarding UPMC/Highmark Continuity of Care Settlement as follows: UPMC and Highmark have announced a settlement agreement that addresses the Consent Decrees’ Continuity of Care...more
The ink was barely dry on the Medicare Physician Sustainable Growth Rate (SGR) fix, and it has already been changed.
One component of the SGR fix, which was just passed in April of this year, was freezing Medicare...more
In September, 2015, OCR and HHS issued a press release announcing a Resolution Agreement with the Cancer Care Group, P.C., which included entry into the agreement, the adoption of a robust compliance plan, and the payment of...more
The Internal Revenue Code was amended in April 2015 as part of the Medicare Access and CHIP Reauthorization Act of 2015 to increase allowable IRS levies against federal payments, such as Medicare receivables, from 30% to 100%...more
On September 9, 2015, Sally Quillar Yates, Deputy Attorney General of the Department of Justice (DOJ) issued a memo entitled “Individual Accountability for Corporate Wrongdoing” to address the issue of incentivizing...more
The Pennsylvania Superior Court has decided the Pennsylvania Peer Review Protection Act does not apply to alleged peer review activity conducted by Blue Cross of Northeastern Pennsylvania, because Blue Cross is not a...more
In July 2015, CMS released proposals to provide several new Stark Law exceptions and to clarify issues regarding existing exceptions. The full text of these proposal and CMS comments and explanations is available below....more
CMS issued a special edition MLN Matters meant to be effective August 1, 2015. The guidance reflects CMS instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the...more
CMS has acknowledged that arrangements among providers to satisfy the Stark exceptions need not be created in a single document. Although a single written document memorializing the key facts of an arrangement could provide...more
In July 2015, CMS released proposals to provide several new Stark Law exceptions and to clarify issues regarding existing exceptions. Over the next few days, I will post comment on what I consider the most significant new...more
In July 2015, CMS released proposals to provide several new Stark Law exceptions and to clarify issues regarding existing exceptions. Over the next few days, I will post comments on what I consider the most significant new...more
By now, everyone knows ICD-10 coding starts October 1, 2015.
Starting October 1, 2015, Medicare claims with dates of service after October 1, 2015 will only be accepted if they contain a valid ICD-10 code. The Medicare...more
Iowa Supreme Court Rejects Ban on Telemedicine Abortions -
An Iowa Board of Medicine rule requires the presence of a physician when abortion inducing drugs are provided....more
The Federal District Court of the Western District of Texas has ruled against the Texas Medical Board and granted TelaDoc’s Motion for a Preliminary Injunction prohibiting the Texas Medical Board from enforcing new rules...more
Medicare Regulations allows CRNA’s to administer anesthesia without physician supervision if the state governor opts out of the regular physician supervision requirement.
Governor Ritter of Colorado opted out in 2010,...more
On June 9, 2015, the OIG issued a Fraud Alert entitled “Fraud Alert: Physician Compensation Arrangements May Result in Significant Liability”. This is just a one page letter warning hospitals and physicians by stating the...more
Cooper v. Pottstown Hospital is another case where a dissatisfied party is attempting to use the federal Anti-Kickback Statute or the Stark Law in litigation arising out of the contracts to which they were willing parties at...more
House Bill 706 has been introduced in the Pennsylvania House. This is a “parity” bill which does the following:
It defines telehealth in such as way as to neither mandate nor prohibit asynchronous or synchronous...more
The Texas Medical Board recently adopted a new rule requiring face to face encounters by physicians with patients before prescribing medication. Teladoc has sued the Texas Medical Board in Federal Court alleging restraint of...more
The ruling by Judge Ward of the Allegheny County Court of Common Pleas highlights another facet of the ongoing dispute between UPMC and Highmark.
On February 18, 2015, Judge Ward of the Allegheny County Court of Common...more
All states have some degree of confidentiality protection for peer review activities and the information generated by those activities, and there is additional federal protection for information gathered and created by...more
MGMA has published the following alert: Congress repeals SGR!
In a significant victory for physician group practices and MGMA, late last night the Senate voted (92-8) to approve the Medicare Access and CHIP...more
Historic SGR repeal passes in House -
Today, the House of Representatives passed the Medicare Access and CHIP Reauthorization Act, H.R. 2, by a vote of 392–37. This legislation permanently repeals the SGR and returns...more