Archive for May, 2014

Some States Mandate Telemedicine Private Reimbursement

Wednesday, May 21st, 2014

By John Fisher, JD, CHC, CCEP

Private Reimbursement for Telemedicine – State Private Payment Mandates 

Failure of private reimbursement sources is one significant factor that impedes the development of telemedicine.  Some states have enacted laws that mandate some level of reimbursement for services provided by telemedicine.  The American Telemedicine Association has reported that 8 additional states have introduced telemedicine reimbursement laws already in 2013.  Those states include Florida, District of Columbia, Connecticut, Mississippi, Nebraska, Indiana, South Carolina, and New Mexico.  Some of the listed states have introduced general requirements that telehealth be reimbursed without discrimination.  Others have addressed more limited coverage .  Read more on this topic in the blog article that I posted on the Health Law Blog.

Read more here: Telemdicine Private Reimbursement

  

Employment Exceptions From Anti-kickback Statute

Tuesday, May 20th, 2014

By John Fisher, JD, CHC, CCEP

employment exception safe harbor regulations

How Broad is the Employee Exception 

Parameters of the Stark Law and Anti-kickback Statute Exception

Both the Anti-Kickback Statute and the Stark Law contain exceptions that apply to employer/employee relationships.  Recent developments in the health law area indicate that there may be limits on the employment exception that were not previously contemplated.  I posted an article on the Health Law Blog that discussed possible limited to compensation structures for employed physicians.

Read more here: Health Law Blog

  

Physician Owned Hospital Expansion – CMS Approval Process

Tuesday, May 20th, 2014

By John Fisher, JD, CHC, CCEP

physician owned hospitals

Expanding Physician Owned Hospitals – Stark Law Approval Process

The Stark Law prohibits physicians from owning interests or having financial relationships with entities that provide “designated health services,” including hospital services, unless an exception exists.  The Stark Law contained an exception that permitted investment in a “whole hospital” but that exception was seriously limited under the Affordable Care Act.  Physician-owned hospitals must now obtain CMS approval of any expansion projects.  CMS regulations define the process and requirements for obtaining CMS approval of expansion projects.

I posted an article on the Health Law Blog that summarizes some of the requirements for obtaining approval for expansion of a physician-owned hospital.

Read more here: Health Law Blog

  

How Much Clinical Integration Is Enough?

Tuesday, May 20th, 2014

By John Fisher, JD, CHC, CCEP

Clinical Integration Attorney

 

Analysis of all available resources makes it clear that there is no single formula for achieving clinical integration and each organization will be unique in the mechanisms and processes that are used to achieve required levels of collaboration and interdependence between providers.  Clinical integration is a process of continual assessment and enhancement.  When we are speaking of clinical integration from an antitrust standpoint, we must determine whether the systems and mechanisms are in place and continuously operating to enhance quality and efficiency.

For more coverage of clinical integration, visit the clinical integration section of the Health Law Blog.

Read more here: Health Law Blog

  

Antitrust Law Application In Rural Areas- Hospital Mergers

Thursday, May 8th, 2014

By John Fisher, JD, CHC, CCEP

Antitrust Law Small Towns

Antitrust In Rural Areas

I just posted a blog article over at the Health Law Blog.  The blog article covers antitrust legal issues in rural healthcare settings.  One might tend to believe that the rather obscure area of antitrust law would have little application in small town America.  After all, most of the legal expertise on the antitrust is located in big cities (Ruder Ware being a major exception).

We are dealing with these antitrust issues on a more frequent basis as clinical integration resumes as a method of addressing health care reform.  These issues can be even more critical in rural areas where there might be only a handful of providers and limited competition.

Read more here: Health Law Blog

  

Medical Record Copying Charges In Wisconsin

Wednesday, May 7th, 2014

Wisconsin Law Release of Patient Medical Records

Wisconsin Law requires health care organizations to provide records are to patients “on request.”  Records can be provided directly to the health care provider subject to payment of the statutory fees.  Patient must deliver an “informed consent” to the organization consenting to release of their records.

Fees were revised as provided below:

(a) A patient’s health care records shall be provided to the patient’s health care provider upon request and, except as provided in s. 146.82 (2), with a statement of informed consent.

(b) The health care provider under par. (a) may be charged reasonable costs for the provision of the patient’s health care records.

(2) The health care provider shall provide each patient with a statement paraphrasing the provisions of this section either upon admission to an inpatient health care facility, as defined in s. 50.135 (1), or upon the first provision of services by the health care provider.

(3) The health care provider shall note the time and date of each request by a patient or person authorized by the patient to inspect the patient’s health care records, the name of the inspecting person, the time and date of inspection and identify the records released for inspection.

 (3f)

(a) Except as provided in sub. (1f) or s. 51.30 or 146.82 (2), if a person requests copies of a patient’s health care records, provides informed consent, and pays the applicable fees under par. (b), the health care provider shall provide the person making the request copies of the requested records.

 (b) Except as provided in sub. (1f), a health care provider may charge no more than the total of all of the following that apply for providing the copies requested under par. (a):

Revised Fees for Patient records:

 Wisconsin Medical Record Maximum Fees through June 30, 2014 — (last year’s fees noted for reference)

Paper copies

  • First 25 pages: $1.04/page ($1.02/page)
  • Pages 26-50: 77 cents/page (76 cents/page)
  • Pages 51-100: 52 cents/page (51 cents/page)
  • Pages 101 and above: 31 cents/page (30 cents/page)

Microfiche or Microfilm: $1.55/page ($1.52/page)

Print of an X-ray (per image): $10.32 ($10.15)

If the requestor is not the patient or a person authorized by the patient

  • Certification of copies: $8.26 ($8.12)
  • Retrieval fee: $20.65 ($20.30)