Tag Archives: Providers

Proving Utility, Demonstrating Value: How to Align the Moving Parts in Personalized Medicine Reimbursement

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Of the many business, operational, legal, regulatory and clinical obstacles standing in the way of widespread delivery of personalized medicine, the single greatest challenge may lie in solving the reimbursement puzzle. Advocates of personalized medicine contend that it results in better care for the patient, as therapy is targeted specific to an individual, and that … Continue reading this entry

Ohio Telemedicine Prescribing and Controlled Substances Laws

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The Ohio Medical Board just last week adopted new rules for telemedicine prescribing of drugs and controlled substances, allowing providers to prescribe drugs via telemedicine without conducting an in-person examination.  Effective March 23, 2017, the new rule 4731-11-09 and rule 7331-11-01 set forth the requirements a physician must follow when prescribing via telemedicine in Ohio.… Continue reading this entry

Top 5 Takeaways from New Michigan Telehealth Law

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Michigan is ringing in 2017 with a new telehealth law. Governor Rick Snyder signed into law SB 0753 on December 21, 2016, imposing new telehealth practice standards, including restrictions on prescribing controlled substances via telemedicine. The new Michigan telemedicine law will take effect March 21, 2017 (a 90-day delay from signature to effective date).  Previously, … Continue reading this entry

Wisconsin Issues New (and Improved!) Telemedicine Rules

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Following a public hearing last month, the Wisconsin Medical Examining Board approved new rules for the practice of telemedicine.  The rules differ notably from its first set of rules proposed in 2015 and considered at a public hearing in January 2016.  After receiving criticism on its first set of rules, the Board withdrew them for … Continue reading this entry

The Top 10 Things you Need to Know About Voluntary Disclosures and Government Refunds

Regulatory-Developments
In February 2016, CMS issued the highly anticipated Final Rule on reporting and returning Medicare Part A and B overpayments. The Final Rule was meant to clear up some of the confusion among providers regarding such overpayments. Summarized below is our Top 10 list of the things you need to know:… Continue reading this entry

Arkansas' New Telemedicine Rules a Small Step Forward

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The Arkansas Legislative Council’s Rules and Regulations Subcommittee approved, on August 16, 2016, proposed regulations which, if accepted by the Arkansas Legislative Council, will remove some restrictions on telemedicine providers in a state that enjoyed the lowest ranking among all states in the American Telemedicine Association’s most recent report. Currently, Arkansas Code 17-80-117, enacted in April 2015, … Continue reading this entry

Missouri Governor Signs New Telemedicine Law

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Missouri’s governor signed into law SB 579 (the “Act”), on June 8, 2016, establishing new telemedicine practice standards, including explicitly allowing a valid physician-patient relationship to be established via telemedicine. Here is a summary of the Act’s key provisions:… Continue reading this entry

CMS Proposes New Medicare Telehealth Coding Rules

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The Centers for Medicare and Medicaid Services (CMS) issued its proposed Medicare Physician Fee Schedule (PFS) for CY 2017 on July 7, 2016. In it, CMS would require practitioners to use a new place of service (POS) code to report telehealth services. The proposed rule also includes several new covered telehealth services. If enacted, the proposed rules are … Continue reading this entry

Florida’s Telehealth Advisory Council Appointed

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Florida’s Agency for Health Care Administration (AHCA) announced, on July 27, 2016, the appointments of 13 representatives to the newly-created Florida Telehealth Advisory Council. The Telehealth Council was created through HB 7087, signed into law by Governor Rick Scott in March, largely as a fact-gathering step as the Legislature continues to consider a telehealth commercial … Continue reading this entry

Report Warns Providers of HIPAA Violations When Responding to Negative Online Reviews

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ProPublica, a public interest investigative newsroom, recently identified more than 3,500 one-star medical reviews on Yelp in which patients complained about privacy issues. ProPublica determined that “in dozens of instances, responses to complaints about medical care turned into disputes over patient privacy.” For example, ProPublica noted consumers giving providers negative reviews on Yelp and providers … Continue reading this entry

Rhode Island’s New Law Requires Health Plans Cover Telemedicine Services

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Rhode Island marks the 31st state to enact a telemedicine commercial reimbursement statute. The Telemedicine Coverage Act (HB 7160B) was signed into law by Rhode Island Governor Gina Raimondo on June 28, 2016, representing a forward step for telehealth providers in a state that historically has held one of the lowest-rankings in the nation for telehealth … Continue reading this entry

IRS Denies Exempt Status for Non-MSSP Accountable Care Organizations

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In April, the IRS released a private letter ruling denying section 501(c)(3) status to an accountable care organization (“ACO”) that contracted with third-party payers outside of the Medicare Shared Savings Program (“MSSP”). I.R.S. Priv. Ltr. Rul. 2016-15-022 (Jan. 15, 2016). The ACO was formed by a non-profit, tax-exempt health system to coordinate a clinically integrated … Continue reading this entry

Alaska Enacts New Telemedicine Law: What Providers Should Know

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Alaska Governor Bill Walker signed SB 74 into law on June 21, 2016, expanding the use of telemedicine in the Last Frontier state. Specifically, SB 74 removes Alaska’s previous in-state presence requirements for prescribing via telemedicine, and authorizes the use of telemedicine in certain clinical practices, including licensed audiologists, speech language pathologists, counselors, marriage and … Continue reading this entry

The State of Telehealth - Policy and Reimbursement Q&A

Regulations
Foley Partner Nathaniel Lacktman, head of the firm’s telemedicine and virtual care practice, participated in a comprehensive Q&A discussing the challenges and opportunities facing the telehealth market with Healthcare Informatics – providing an in-depth look at key trends in the industry, including the variations in state laws, reimbursement issues and opportunities. The discussion begins with insights … Continue reading this entry

Louisiana’s New Telemedicine Law Opens Doors, Removes Barriers

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Louisiana’s governor signed into law, HB 570, (the “Act”), eliminating a prior requirement that physicians practicing telemedicine maintain an office in Louisiana or contract with in-state providers. The Act also changes the telemedicine modality required for a patient encounter from “two-way video” technology to “interactive audio” (provided the modality is sufficient to meet the same … Continue reading this entry

DOJ and North Carolina Challenge Anti-Steering and Tiering Provisions in Managed Care Contracts

CMS Releases Medicare Part B Supplier Billing and Payment Data
The Department of Justice’s antitrust division (the “DOJ”)and the State of North Carolina (“NC”) jointly sued, on June 9, 2016, Carolinas HealthCare System (“CHS”), the largest healthcare system in North Carolina, over anti-steering restrictions in its managed care contracts that the DOJ believes limits competition. In its complaint, the DOJ and NC claim that CHS used its … Continue reading this entry

FCA Penalties Slated to Nearly Double This Year

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A little known federal agency, the Railroad Retirement Board (“Board”), which administers retirement-survivor and unemployment-sickness benefit programs for railroad workers, published an interim final rule on May 2, 2016 raising the amounts of penalties “under the Board’s jurisdiction.” Among these are the penalties authorized by the Federal False Claims Act (“FCA”).  The Board proposes increasing the … Continue reading this entry

CMS Abandons Payment Cut Imposed By Two-Midnight Rule

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In the Fiscal Year (FY) 2014 Inpatient Prospective Payment System (IPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) revised its Medicare policy for determining whether hospital encounters will be considered appropriately inpatient or outpatient. The status distinction has important consequences for both the provider and the beneficiary, including differences in co-insurance and … Continue reading this entry

Virginia Telehealth Law: What You Need to Know

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Virginia has made strides to expand the telehealth offerings available to its residents and the Old Dominion took another step forward advancing telemedicine when it enacted a bill amending Virginia Code § 38.2-3418.16 to expand commercial insurance coverage of telemedicine-based services. Additionally, the Virginia Board of Medicine last year published Telemedicine Guidelines to instruct practitioners … Continue reading this entry

Differences in Medical Opinion Are Not False Claims Act Violations

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In an important win for hospice and other health care providers facing claims under the False Claims Act (FCA), a federal court in Alabama gave a summary judgment victory last week to hospice provider Aseracare Inc. Key Takeaway A difference in medical opinion between the Government’s expert physician and the physicians who certified a patient’s … Continue reading this entry

West Virginia's New Telemedicine Practice Standards & Remote Prescribing Laws

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West Virginia Gov. Earl Ray Tomblin (D) signed into law, on March 24, 2016, a new bill (House Bill No. 4463) implementing a variety of telemedicine practice standards and remote prescribing rules in the Mountain State. Effective June 11, 2016, the bill passed the House and Senate unanimously, reflecting strong bi-partisan support. The new statute … Continue reading this entry

Key Takeaways From Indiana's New Telemedicine Law

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Indiana Gov. Mike Pence (R) signed into law, on March 21, 2016, a new bill (House Act No. 1263) implementing a variety of telemedicine practice standards and remote prescribing rules in the Hoosier State. Effective July 1, 2016, the new law replaces the old Indiana Telehealth Pilot Program, which is set to self-expire on that … Continue reading this entry

At The Intersection of New Bundled Payment Programs and New Discharge Rules: Private Equity Opportunities

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Recently, CMS has promulgated new bundled payment rules for Comprehensive Joint Replacement (CJR) that require the mandatory participation of approximately 800 hospitals across the US. This bundle includes not only the inpatient DRG care, but also 90 days of post-discharge care. Contemporaneously, CMS has initiated rulemaking which totally revamps the discharge planning process for hospitals by requiring … Continue reading this entry

Louisiana Telemedicine Practice Rules: What Providers Need to Know

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Louisiana’s Board of Medical Examiners (the “Board”) enacted regulations in the fall amending the prior practice standards for telemedicine, the requirements for obtaining a telemedicine permit, and the rules on remote prescribing of controlled substances. The new rules explicitly state that an initial in-person visit is not required if the technology is sufficient to provide … Continue reading this entry