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Clinical Integration – Credentialing and HCQIA Compliance

WebClinically integrated networks present unique credentialing issues that are normally not present in hospital or facility credentialing. These unique issues stem from …

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URL: http://physicianslawyers.com/posts/clinical-integration-credentialing-and-hcqia-compliance/

CMS Extends Compliance Date for New Home Health Conditions …

WebIn February, we reported on revisions to the Conditions of Participation for Home Health Agencies (HHA) released by the Centers for Medicare Medicaid Services (CMS).

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Physician Orders – Definition and Reimbursement Implications

WebPhysician orders hold a great deal of significance in health care. The root purpose of a physician order is to direct other providers to furnish certain services. …

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Providing Protected Health Information in Response to Subpoena

WebOCR Citation for Improper Disclosure of PHI in Response to a Subpoena. A health care provider or other covered entity under HIPAA is permitted to disclose …

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Verbal Orders Documentation and Authentication

WebAuthentication of Verbal Orders by Ordering Physician. In terms of timing, Medicare guidance requires the ordering physician to sign the verbal order promptly. Some states, …

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17 Examples SAMHSA Payment and Health Care Operations

WebExamples of Disclosures of Part 2 Records for Payment and Health Care Operations. In regulations released in January of 2018, SAMHSA included a list of 17 …

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Medical Alerts – HIPAA Implications of Flagging Patient Records

WebDentist Revises Process to Safeguard Medical Alert PHI. A recent OCR investigation of a dental practice’s flagging of patients records highlights a potential HIPAA violation. The …

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Wisconsin Outlines Standards for Telehealth In Mental Health …

WebWisconsin Guidance On Telemedicine in Mental Health and Substance Abuse Programs. The Wisconsin Division of Quality Assurance (DQA), issued new DQA …

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Authentication of Verbal Orders by Other Responsible Practitioner

WebAt minimum, facility policy should echo the CMS comments regarding the appropriate scope of use of verbal orders. Practices can be audited to determine whether …

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Criminal Exposure for Failing to Repay Known Overpayment

WebA violation of the statute is a felony and is punishable by a maximum of five years in prison and a fine of $250,000 for individuals or $500,000 for corporations. The …

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Faxing Patient Health Information to Wrong Number – …

WebThe office informed all its employees of the incident and counseled staff on proper faxing procedures. Two things pop about about this instance. First, this was …

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When is a Referral Mandate for Employed Physicians Permitted …

WebWhen Employed Physicians be Required to Make Referrals for Designated Health Services. The Stark Law Regulations include a provision that dictates the …

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Co-Branding Requirements Under Medicare Advantage Marketing …

WebPlans/Part D Sponsors that choose to co-brand with providers/pharmacies must include on marketing materials (other than ID cards) the language in section 50.9. …

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Medical Director Agreement Payments May Be Source of Stark …

WebMEDICAL DIRECTOR PAYMENTS AS STARK LAW VIOLATIONS. The relatively recent case serves as a reminder of the potential exposure to Stark Law liability …

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Dermatology Practice Fraud and Abuse Risks Identified in Florida …

WebThe unnecessary charges were alleged to have totaled around $49 million over a 6-year period. The dermatologist did not admit wrongdoing in the settlement. …

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Notice of Restriction on Re-Disclosure SAMHSA Records

WebThe new 2018 Rules create an abbreviated notice that is 80 characters long to fit in standard free-text space within health care electronic systems. The abbreviated …

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Ambulatory Surgery Center Exclusions – ASC Safe Harbor …

WebMany operating agreements that govern the rules relating to ambulatory surgery center ownership actually create legal compliance risk. It is critical that the …

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Designated Health Services Definition I Stark Law DHS Defined

WebDesignated health services (DHS) means any of the following services (other than those provided as emergency physician services furnished outside of the U.S.), as …

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